Psychologist Peer Reviewer - Remote anywhere USA - Kentucky license required

Lensa; Nashville (TN); Remote; USD 89,000 - 177,000; Full time

Job summary

A leading healthcare organization is seeking a Psychologist Peer Reviewer to conduct clinical reviews and make benefit coverage determinations. This full-time remote role requires a Kentucky license and offers a competitive salary and comprehensive benefits.

Benefits

Comprehensive benefits

Incentive programs

Stock purchase options

401k contributions

Qualifications

• Independently licensed doctoral-level Psychologist in Kentucky.
• 3+ years of post-licensure experience.

Responsibilities

• Conduct clinical reviews and manage appeals of denied services.
• Participate in consultations and trainings.

Skills

Communication

Negotiation

Collaboration

Prioritization

Education

Ph.D. or Psy.D.

Tools

Microsoft Office

Job description

Psychologist Peer Reviewer - Remote anywhere USA - Kentucky license required

1 day ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

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 Reviewer is for an Outpatient Public Sector or Applied Behavior Analysis role, involving 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:

• 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 Reviewer will 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 requiring 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 Kentucky but do not need to reside in Kentucky.

Primary Responsibilities:

• Conduct clinical reviews, including requests for service authorization that a Master’s level employee cannot authorize
• Review cases involving ongoing outpatient care exceeding normative standards
• Handle requests for non-standard outpatient services (e.g., ABA, Psychosocial Rehabilitation)
• Manage 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, along with development opportunities for other roles you may be interested in.

Required Qualifications:

• Independently licensed doctoral-level Psychologist (Ph.D. or Psy.D.) in Kentucky
• Ability to obtain additional state licenses as needed
• 3+ years of post-licensure experience
• Experience dealing with insurance
• Advanced proficiency with Microsoft Office (Word, Outlook, TEAMS, Excel, Access)
• Ability to prioritize multiple demands within strict turnaround times
• Ability to work independently and collaboratively
• Excellent written and verbal communication and negotiation skills
• Secure, private home office with broadband internet

Preferred Qualifications:

• APA-accredited training and internship
• Experience in managed care settings
• Peer review experience with managed care
• Experience with Medicaid/Medicare services and HCPC codes
• Clinical experience with Substance Use Disorders

The salary range is $89,800 to $176,700 annually, based on full-time employment and various factors including experience, education, and location. Benefits include comprehensive packages, incentive programs, stock purchase options, and 401k contributions. The application will remain open for at least 2 business days or until a sufficient candidate pool is reached.

Our mission is to help people live healthier lives and improve health equity. We are committed to diversity, inclusion, and environmental responsibility. We are an Equal Opportunity Employer and a drug-free workplace, requiring a drug test before employment.