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in St. Louis, MO

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Hours Full-time, Part-time
Location St. Louis, MO
St. Louis, Missouri

About this job


You're looking for something bigger for your career. How about inventing the future of health care? Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Join us. Take this opportunity to start doing your life's best work. (sm)


 


The role of the Behavioral Clinic Consultant, Peer Reviewer involves applying medical necessity and benefit plan criteria to these cases resulting in authorization of treatment if medically necessary, authorization of a modified treatment plan as appropriate, or issuing/upholding an adverse benefit determination if indicated. In addition to these primary duties, a Psychologist Reviewer will also participate in peer consultations, staff meetings, and trainings; entering determinations within federal, state, and local guideline requirements; and performance of other duties as required by the reviewer's manager.

 

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



  • Requests for psychological or neuropsychological testing

  • Review of outpatient treatment plans for services that on initial review, a Masters level employee is unable to grant authorization

  • Review of ongoing outpatient care in cases where the member's length of stay exceeds normative standards

  • Requests for non-standard outpatient services (extended-length visits, an in-network accommodation)

  • Appeals of previously denied services or claims for outpatient non-MD services up to and including Intensive Outpatient Programming

Requirements



Required Qualifications:




  • Must be a licensed doctoral level (Ph.D. or Psy.D.) Psychologist. License must be current and unrestricted


  • Minimum of 3+ years post licensure experience


  • Strong organization and time-management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements


  • Strong written and verbal communication and negotiation skills


  • Able to work well both independently and collaborate with others on a clinical team


  • Enjoy a fast paced environment


  • Previous clinical review experience


  • Strong computer skills--must be able to type, navigate Windows OS, Outlook, and Word

 


Preferred Qualifications:




  • Prior experience working in a managed care setting


  • Prior peer review experience with managed care


  • Neuropsychological testing experience


  • Clinical experience in higher levels of care (Intensive Outpatient)


  • Advanced computer skills using Excel and Access Databases

 
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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)




Diversity creates a healthier atmosphere: 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 Clinic Consultant, Behavioral, Peer Review, Psychologist, Behavioral Consultant, neuropsychological, outpatient treatment, Ph.D., Psy.D., managed care, St. Louis, MO, Missouri