The role of the Behavioral Clinic Consultant, Peer Reviewer for ALERT Public Sector Kentucky Medicaid involves applying medical necessity and benefit plan criteria to primarily Medicaid and Medicare cases and making clinical determinations to continue coverage of medically necessary treatment, shaping and modifying treatment as appropriate, or issuing an adverse benefit determination if treatment is not medically necessary. Services reviewed may include, but are not limited to, the following:

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• Traditional outpatient therapy, including requests for extended length sessions or single case agreements
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• State-specific Medicaid services ( Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment)
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The Peer Reviewer will also participate in peer consultations, staff meetings, and trainings; be responsible for composing and entering clinical determinations that comply with all federal, state, and local guideline requirements; and perform other duties as required by the reviewers manager and director.

Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

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• Review of requests for service authorization that upon initial review, a Masters level employee is unable to authorize coverage for
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• Review of ongoing outpatient care in cases where the members length of stay exceeds normative standards
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• Requests for authorization of outpatient services (e.g. Psychosocial Rehabilitation, Case Management, an in-network accommodation)
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• Appeals of previously denied services
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Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

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• Kentucky licensed doctoral level Psychologist (Ph.D. or Psy.D.). License must be current, allow for full independent practice and be unrestricted
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• Ability to obtain additional state licenses to meet growing business needs
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• 3+ years post-licensure experience
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• Ability to prioritize multiple demands within strict turn-around-time requirements and track multiple state and business nuances for cases reviewed
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• Work independently and collaborate with others on a clinical team
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• Experience working with insurance agencies
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• Solid computer skills, including facility with Windows OS, Outlook, Word, and Excel
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• Secure, private area of your home to set up an office, and access to a broadband ISP
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• Available to work during normal business hours full-time Monday through Friday
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• If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:

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• APA accredited training and internship
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• Prior experience working in a managed care setting
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• Prior peer review experience with managed care
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• Experience with Public Sector (Medicaid/Medicare) services and HCPC codes
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• Clinical experience with children and adolescents
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• Clinical experience with Substance Abuse diagnoses
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• Advanced computer skills using Excel and Access Databases
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• Solid written and verbal communication and negotiation skills
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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