The Licensed Psychologist, Peer Reviewer for Applied Behavior Analysis (ABA) Services evaluates requests for initial and continued coverage of ABA treatment and assessment services. The Peer Reviewer applies applicable clinical criteria, benefit-plan requirements, and federal, state, and local requirements; discusses clinically appropriate treatment considerations with treating providers; and issues clinical determinations, including adverse benefit determinations when requested services do not meet medical-necessity requirements.
Primary Responsibilities:- Review initial and continued-service requests for ABA treatment and assessment services for commercial and Medicaid plans.
- Apply clinical criteria, benefit-plan requirements, and applicable federal, state, and local requirements to each review.
- Conduct peer-to-peer consultations and discuss clinically appropriate treatment considerations with treating providers.
- Compose and enter clear, timely clinical determinations, including adverse benefit determinations when requested services do not meet medical-necessity requirements.
- Review requests for single-case agreements and appeals of previously denied services.
- Participate in peer consultations, staff meetings, and training activities.
- Perform other duties as assigned.
Required Qualifications:- Licensed doctoral level Psychologist (Ph.D. or Psy.D.) Your license must be current, allow for full independent practice, and be unrestricted [You may be asked to obtain additional state licenses to meet growing business needs]
- 3+ years of post-licensure experience
- Clinical experience with Autism Spectrum Disorder
- Experience working with managed care entities
- Proficiency is MS Office Suite
- Ability to type proficiently, and for a significant portion of your day comfortably, while speaking on the phone
- Solid organizational and time-management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements and track multiple state and business nuances for the cases you review
- Ability to work well independently and collaborate with others on a clinical team
- Solid written and verbal communication and negotiation skills
- Thrive in a fast-paced environment
- Have a secure, private area of your home to set up an office, and access to a broadband ISP
- Available to work full-time during normal business hours Monday through Friday
- Ability and willingness to obtain additional state licenses based on business needs.
Preferred Qualifications:- Psychologists licensed in AZ, CA, FL, GA, IN, KY, MA, MN, or MS
- BCBA, BCBA-D, LBA (in addition to being a licensed psychologist)
- APA accredited training and internship
- Applied Behavior Analysis training and/or experience
- Clinical experience with children and adolescents
- Experience working in a managed care setting
- Peer review experience with managed care
- Behavior Modification expertise
- Advanced computer skills using Excel and Access Databases
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
