About this role
Optum - Psychologist Peer Reviewer (Outpatient Public Sector / Applied Behavior Analysis)
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization 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 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 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 that requires availability to work a standard schedule: Monday through Friday (8:30am to 5pm CST)
If you are located in Florida, you will have the flexibility to work remotely* as you take on some tough challenges.
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 Florida
- Ability to obtain additional state licensures to meet growing business needs
- 3+ years of post-licensure experience
- Experience working with insurance companies to acquire authorizations, file claims, conduct peer reviews, etc.
- 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 t