The successful Optum Alaska Clinical Psychologist candidate will be a licensed Psychologist who has working knowledge and experience with serving children, adolescents, and adult Waiver target populations, and who is capable of reviewing authorization, utilization services, and psychological testing requests.
The primary responsibility of the Clinical Psychologist is to ensure the delivery of cost effective quality care that incorporates recovery, resiliency and person-centered services. They are also responsible for Level of Care guidelines, utilization management protocols, oversight and management with the Medical Director and Clinical Program Director as well as all utilization review, management and care coordination activities. In addition, they will provide clinical oversight to the clinical staff, and keep current regarding prevalent treatment protocols and philosophies; including those that address consumer cultural preferences and for ensuring that the usage of psycho-social rehabilitation services and psychological testing requests are aligned with clinical necessity. The Clinical Psychologist will also be responsible for maintaining the clinical integrity of the program; providing oversight to utilization management and quality staff; including consultation to community based clinicians. This includes providing timely services for the Optum operation and communication regarding necessity review and recommendations, service denial reviews, grievance issues, and clinical best practices guideline development.
- Responsible for achieving appropriate utilization by performing reviews, denials, peer reviews and appeals; consulting with care management staff; using data to identify opportunities for improvement and implementing strong action plans for Medicaid enrollees
- Responsible for implementing a recovery philosophy working closely with the Recovery & Resiliency staff by maintaining a knowledge base in rehabilitation and recovery principles and innovations; modeling principles of engagement, empowerment and learning with colleagues and employees, and training all staff in the practical implications of these principles with a particular emphasis on care management, alternative levels of care and network sufficiency
- Provide periodic supervision/in-service training to both Optum clinical staff and other staff as needed focusing on medical necessity, reason(s) for continued services, state requirements, appropriate practice and engagement, empowerment, recovery and rehabilitation
- Ensure receipt of mental health services
- Ensure systematic screening for behavioral health related disorders by using standardized and/or evidence-based approaches
- Promote preventive behavioral health strategies
- Provide peer to peer reviews and consultations
- Act as a liaison with Optum service area facilities, providers, and agencies as requested
- Provide all necessary reports on UM activities
- Complete all medical necessity reviews when Care Managers are unable to authorize rehabilitation continued stay
- Provide sufficient electronic documentation in the consumer record when a denial is made for either adult or child/adolescent
- Establish criteria and procedures for the Clinical Director review of clinical cases
- Provide consultation to Optum management and staff regarding such issues as clinical standards, policies, procedures, recovery and resiliency and best practices
- Conduct clinical reviews of contracted provider clinical records as requested
- Participate in Quality Assurance activities and audits
- Ability to be a successful Care Management advocate for local Alaskans
- Licensed Psychologist.
- Active, unrestricted Alaska license
- Minimum 7 years of clinical experience
- Experience with multiple disciplines addressing broad range of diagnostic issues
- Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery
- PC proficiency, familiarity with computerized clinical data systems, data analysis and strong organizational skills necessary
- Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management
- Excellent communication, negotiation and customer service skills
- Experience in developing creative, innovative solution-based programs and initiatives
- Minimal local travel in Anchorage, AK
- Experience with child and adolescent psychology
- One year experience in managed care conducting utilization
- Care Management Experience
- Demonstrated commitment to assisting people to maintain in the community with maximum independence and self-sufficiency and understanding of the appropriate use of wraparound, in home stabilization services and natural community supports to maximize community tenure
- Ability to perform a highly diverse level of tasks and deliver quality outcomes in alignment with Optum mission
- Experience working with community based programs and resources designed to aid the Medicaid population
- Experience with Waiver target populations
OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.