The role of the Psychologist Peer Review for ALERT involves applying clinical criteria and benefit plan requirements to Commercial, Medicaid, and Medicare cases, and making clinical and /or benefit determinations to continue coverage of treatment, shaping and modifying treatment as appropriate, or issuing an adverse benefit determination if applicable criteria is not met.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Standard outpatient treatment, including requests for extended length sessions or single case agreements
- State-specific Medicaid services (e.g. Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)
- Intensive Outpatient services for both Mental Health and Substance Abuse
- Participate in peer consultations, staff meetings, and trainings; entering determinations within federal, state, and local guideline requirements; and perform of other duties as required by the reviewer's manager
- Conduct Non-MD clinical reviews of the following type during a typical workday
- Requests for psychological or neuropsychological testing
- Review of outpatient treatment plans for services that are sent for Peer Review that do not appear to meet clinical criteria and/or when there are concerns about the quality of care
- Review of ongoing outpatient care in cases where the member's treatment episode exceeds normative standards
- Requests for non-standard outpatient services (extended-length visits, an in-network accommodation, intensive outpatient program with no MD involvement)
- Appeals of previously denied services or claims for outpatient non-MD services up to and including Intensive Outpatient Programming
You'll 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:- Licensed doctoral level (Ph.D. or Psy.D.) Psychologist
- 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
- Experience working with insurance agencies
- Computer skills, including facility with Windows OS, Outlook, Word, and Excel
- Proven ability to type proficiently while speaking on the phone
Preferred Qualifications:- Experience working in a managed care setting
- Experience performing Peer Reviews
- Experience with commercial, Medicaid and Medicare lines of business
- Experience with CPT and HCPC codes
- Clinical experience in higher levels of care (Intensive Outpatient)
- Clinical experience with children and adolescents
- Clinical experience with Substance Abuse diagnoses
- Clinical experience with Evidence-Based Treatment
- Advanced computer skills using Excel and Access Databases
- Proven solid organizational and time management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements
- Proven solid written and verbal communication and negotiation skills
- Proven ability to work well independently and collaborate with others on a clinical team
- Proven ability to enjoy a fast paced, changing environment
- Candidates located in Mountain or Pacific Time Zones
*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 to $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.
