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Licensed Psychologist Peer Reviewer - Remote

Company: UnitedHealth Group
Location: Las Vegas
Posted on: September 14, 2023

Job Description:

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)--


The role of the Behavioral Clinic Consultant, Peer Reviewer for ABA Services involves applying medical necessity and benefit plan criteria to service requests for initial and continued coverage of ABA treatment, shaping and modifying treatment as appropriate, and issuing an adverse benefit determination if treatment is not medically necessary. Services reviewed may include, but are not limited to, the following:

--------------- Applied Behavior Analysis service requests for both Commercial and Medicaid Plans

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.

The Psychologist Reviewer may conduct clinical reviews of the following type during a typical workday:

  • Review of requests for ABA and Assessment service authorization that upon initial review, a Masters level employee is unable to authorize
  • Requests for Single Case Agreements
  • Appeals of previously denied services
    Work schedule will be Monday to Friday 8:00 AM - 5:00 PM CST. --
    You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.--


    Primary Responsibilities:--

    • Participate in peer consultations, staff meetings, and trainings; for 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
      • Requests for Applied Behavioral Analysis
      • 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 national standards of care for best practices
      • Requests for non - standard outpatient services (eg, 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
        • Proven computer skills, including facility with Windows OS, Outlook, Word, Teams and Excel
        • Designated secure workspace and access to install secure high speed internet via cable/DSL in home

          Preferred Qualifications:--

          • Experience with Applied Behavioral Analysis services and the treatment of autism Spectrum disorders
          • Clinical experience with children and adolescents
          • Diplomate of the American Board of Professional Psychology (ABPP)
          • ASPPB Certificate of Professional Qualification (CPQ)
          • 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 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

            California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $85,000 to $167,300. 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 employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy--

            At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.--------


            Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.------


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

Keywords: UnitedHealth Group, Las Vegas , Licensed Psychologist Peer Reviewer - Remote, Healthcare , Las Vegas, Nevada

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