Licensed Psychologist, Peer Reviewer - Telecommute

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

The role of the Behavioral Clinic Consultant, Peer Reviewer (Telecommute) 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:
  • Traditional outpatient therapy, including requests for extended length sessions or single case agreements
  • State-specific Medicaid services (Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment)

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 reviewer's manager and director.

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

Available to Work: Monday through Friday (9am to 5pm CST)

Primary Responsibilities:
  • Reviewing requests for service authorization that upon initial review, a masters level employee is unable to authorize coverage
  • Review of ongoing outpatient care in cases where the member's length of stay exceeds normative standards
  • Requests for authorization of outpatient services (e.g. Psychosocial Rehabilitation, Case Management, an in-network accommodation)
  • Appeals of previously denied services

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:
  • Independently licensed doctoral level Psychologist (Ph.D. or Psy.D.)
  • Active Kentucky license as a Psychologist
  • Ability to obtain additional state licensures to meet growing business needs
  • 3+ years post-licensure experience
  • Experience working with insurance agencies
  • Ability to prioritize multiple demands within strict turnaround time requirements and track multiple state/business nuances for cases reviewed
  • Advanced proficiency using Microsoft Office Applications (Word, Outlook, Teams, Excel and Access Database)
  • Advanced written and verbal communication and negotiation skills required
  • Secure, private area of your home to set up an office, and access to a broadband ISP

Preferred Qualifications:
  • APA accredited training and internship
  • Clinical experience with children and adolescents
  • Clinical experience with Substance Abuse diagnoses
  • Experience working in a managed care setting
  • Experience with autism and ABA services
  • Peer review experience with managed care
  • Experience with Public Sector (Medicaid/Medicare) services and HCPC codes
  • Work independently and collaborate with others on a clinical team
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $79,700 to $142,600. The salary range for Connecticut / Nevada residents is $87,900 to $156,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group's 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.

Job Keywords: Behavioral Clinical Consultant, Peer Review, Psychologist, Ph.D., Psy.D., KY License, Kentucky license, Medicaid, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote

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