Licensed Psychologist – ABA Peer Reviewer (Managed Care)

Optum; Eden Prairie (MN); Remote; USD 90,000 - 130,000; Full time

Job summary

Optum, a global health services team, seeks a Licensed Psychologist to review ABA treatment requests for commercial and Medicaid plans, applying clinical criteria and plan requirements. You will discuss treatment considerations with providers and issue determinations, including adverse determinations when needed.

The role demands independent work within a clinical team and strong communication. Required credentials include a doctoral degree and 3+ years post-licensure, with experience in autism

Qualifications

• Licensed doctoral-level Psychologist with current, unrestricted license.
• 3+ years post-licensure experience.
• Clinical experience with Autism Spectrum Disorder.
• Experience with managed care entities.
• Proficient in MS Office.
• Strong typing and telephony skills.
• Excellent organizational and time-management abilities.
• Able to work independently and on a clinical team.
• Strong written and verbal communication and negotiation skills.
• Comfortable in a fast-paced environment.

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 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.

Skills

Licensed psychologist

Post-licensure experience

Autism Spectrum Disorder experience

Managed care experience

MS Office proficiency

Typing on phone

Organizational/time management

Written and verbal communication

Independent work and collaboration

Fast-paced environment

Education

Ph.D. or Psy.D.

Tools

MS Office Suite

Job description

Optum, a global health services team, seeks a Licensed Psychologist to review ABA treatment requests for commercial and Medicaid plans, applying clinical criteria and plan requirements. You will discuss treatment considerations with providers and issue determinations, including adverse determinations when needed.

The role demands independent work within a clinical team and strong communication. Required credentials include a doctoral degree and 3+ years post-licensure, with experience in autism