Psychologist - Peer Review (Telecommute Opportunity) - Full-time / Part-time

For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral 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 Psychologist - Peer Review for ALERT Public Sector involves applying medical necessity and benefit plan criteria to Medicaid and/or Medicare cases and making clinical determinations to continue coverage of medically necessary treatment, shaping and modifying treatment as appropriate, or issuing an adverse benefit determination if treatment is not medically necessary.
 
Primary Responsibilities:    

Traditional outpatient therapy, including requests for extended length sessions or single case agreements   
State - specific Medicaid services (e.g. Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)   
Intensive Outpatient services for both Mental Health and Substance Abuse    
Psychological /Neuropsychological Testing service requests    
The Psychologist Reviewer will also participate in peer consultations, staff meetings, and trainings; be responsible for entering determinations within federal, state, and local guideline requirements; and perform of other duties as required by the reviewer’s manager
The Psychologist 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 continue coverage for
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

Required Qualifications:

Licensed doctoral level (Ph.D. or Psy.D.) Psychologist in your state of residence 
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)
You must have a minimum of 3 years post - licensure experience 
Strong organizational 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  
Work well independently and collaborate with others on a clinical team  
Enjoy a fast paced environment 
Experience working with insurance agencies   
Computer skills, including facility with Windows OS, Outlook, Word, and Excel 
Ability to type proficiently while speaking on the phone  
Preferred Qualifications:

Prior experience working in a managed care setting 
Experience performing Peer Reviews
Experience with Public Sector (Medicaid/Medicare) services and HCPC codes  
Clinical experience in higher levels of care (Intensive Outpatient) 
Clinical experience with children and adolescents 
Clinical experience with Substance Abuse diagnoses 
Advanced computer skills using Excel and Access Databases
Residence and licensure in the state of Missouri is highly preferred
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: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer 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.
 
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
 
 
Job Keywords: psychologist, therapist, counselor, Psy.D., Ph.D., mental health, behavioral health, peer review, Medicaid, managed care, medical necessity, telecommute, telecommuter, St. Louis, Maryland Heights, St. Louis, MO, Missouri