Behavioral Clinical Consultant, Peer Reviewer

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.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

The role of the Behavioral Clinical Consultant, Peer Reviewer for ABA Services involves applying clinical and benefit plan criteria to service requests for initial and continued coverage of ABA treatment, shaping and modifying treatment as appropriate, and issuing an adverse benefit determination if treatment is not medically necessary. Services reviewed may include, but are not limited to, the following: 

• Applied Behavior Analysis service requests for both Commercial and Medicaid Plans

The Peer Reviewer will also participate in peer consultations, staff meetings, and trainings; be responsible for composing and entering clinical determinations that comply with all federal, state, and local guideline requirements; and perform other duties as required. 

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

• Clinical review of requests for ABA and Assessment services
• Requests for Single Case Agreements 
• 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:

• Licensed doctoral level Psychologist (Ph.D. or Psy.D.). Your 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.]
• 3+ years of post-licensure experience
• Clinical experience with Autism Spectrum Disorder
• Experience working with managed care entities
• Solid organizational and time-management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements and track multiple state and business nuances for the cases you review.
• Solid written and verbal communication and negotiation skills
• Ability to work well independently and collaborate with others on a clinical team
• Ability to thrive in a fast-paced environment
• Solid computer skills, including facility with Windows OS, Outlook, Word, and Excel
• Ability to type proficiently, and for a significant portion of your day comfortably, while speaking on the phone 
• Have a secure, private area of your home to set up an office, and access to a broadband ISP
• Available to work full-time during normal business hours Monday through Friday

Preferred Qualifications:

• BCBA, BCBA-D, LBA (in addition to being a licensed psychologist) 
• Licensed in AZ, CA, FL, GA, IN, KY
• Psychologist licensed in AZ, CA, FL, GA, IN, KY, MA, MN 
• APA accredited training and internship
• Applied Behavior Analysis training and/or experience
• Clinical experience with children and adolescents
• Experience working in a managed care setting
• Peer review experience with managed care
• Behavior Modification expertise
• Advanced computer skills using Excel and Access Databases

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.