Psychologist Peer Reviewer - Remote anywhere USA - Kentucky license required

UnitedHealth Group; Louisville (KY); Remote; USD 89,000 - 177,000; Full time

Job summary

Join a forward-thinking organization dedicated to improving health outcomes through technology and care. As a Psychologist Peer Reviewer, you will play a crucial role in assessing insurance benefit coverage for outpatient services. This full-time position offers the flexibility to work remotely from anywhere in the U.S., while ensuring compliance with federal and state regulations. If you are a licensed psychologist with a passion for making a difference, this opportunity allows you to utilize your expertise in a supportive and inclusive environment, helping to advance health equity on a global scale.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Qualifications

• Must be licensed in Kentucky to practice as a psychologist.
• Experience in managed care and peer review is preferred.

Responsibilities

• Conduct clinical reviews and make coverage determinations.
• Participate in consultations and staff meetings.

Skills

Independently licensed doctoral level Psychologist (Ph.D. or Psy.D.)

3+ years of post-licensure experience

Experience dealing with insurance

Advanced proficiency using Microsoft Office Applications

Proven ability to prioritize multiple demands

Proven ability to work independently

Advanced written and verbal communication skills

Education

Doctoral degree in Psychology

Tools

Microsoft Office (Word, Outlook, TEAMS, Excel, Access)

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together

Psychologist Peer Revieweris for an Outpatient Public Sector or Applied Behavior Analysis which involves applying clinical and benefit plan criteria to Commercial, Medicaid, and/or Medicare cases to make insurance benefit coverage determinations.

Services reviewed may include, but are not limited to, the following:

• Traditional outpatient psychotherapy visits
• State-specific Medicaid services (Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)
• Applied Behavior Analysis service requests

The Psychologist Peer Reviewerwill also participate in consultations, staff meetings, and trainings; be responsible for composing and entering clinical determinations that comply with all federal, state, and local requirements; and perform other duties as required by the reviewer’s manager.

This is a full-time salaried position that requires availability to work a standard schedule:

Monday through Friday (9am to 5pm CST)

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Candidates must be licensed in the state of Kentucky but DO NOT need to reside in Kentucky.

Primary Responsibilities:

• May conduct clinical reviews of the following type during a typical workday
• Requests service authorization that upon initial review which a Master’s degree level employee is unable to authorize coverage
• Ongoing outpatient care in cases where the member’s length of stay or frequency of visits exceeds normative standards
• Requests for non-standard outpatient services (e.g. ABA, Psychosocial Rehabilitation, 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.) in the state of Kentucky
• Ability to obtain additional state licensures to meet growing business needs
• 3+ years of post-licensure experience
• Experience dealing with insurance
• Advanced proficiency using Microsoft Office Applications (Word, Outlook, TEAMS, Excel, and Access Database)
• Proven ability to prioritize multiple demands within strict turnaround time requirements and track multiple state/business nuances for cases reviewed
• Proven ability to work independently and collaborate with others on a clinical team
• Proven advanced written and verbal communication and negotiation skills
• Secure, private area of your home to set up an office, and access to a broadband ISP

Preferred Qualifications:

• APA accredited training and internship
• Experience working in a managed care setting
• Peer review experience with managed care
• Experience with Public Sector (Medicaid/Medicare) services and HCPC codes/services
• Clinical experience with Substance Abuse diagnoses

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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