Licensed Psychologist, Peer Reviewer - Remote in Florida

About the Role

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. As a Psychologist Peer Reviewer, you will apply clinical and benefit plan criteria to Commercial, Medicaid, and/or Medicare cases to make insurance benefit coverage determinations for Outpatient Public Sector or Applied Behavior Analysis services. Services reviewed may include traditional outpatient psychotherapy visits, state-specific Medicaid services (Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.), and Applied Behavior Analysis service requests.

You will participate in consultations, staff meetings, and trainings; compose and enter clinical determinations compliant with federal, state, and local requirements; and perform other duties as assigned by your manager.

Responsibilities

• Conduct clinical reviews of requests for service authorization where a Master's degree-level employee is unable to authorize coverage.
• Review ongoing outpatient care cases where the member's length of stay or frequency of visits exceeds normative standards.
• Evaluate requests for non-standard outpatient services (e.g., ABA, Psychosocial Rehabilitation, in-network accommodations).
• Handle appeals of previously denied services.

Requirements

• 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, and conduct peer reviews.
• 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 track state/business nuances for cases reviewed.
• Proven ability to work independently and collaborate with a clinical team.
• Advanced written and verbal communication and negotiation skills.
• Secure, private home office space with access to a broadband ISP.
• Permanent residence in the state of Florida.

Preferred Qualifications

• APA-accredited training and internship.
• Experience working in a managed care setting.
• Experience with Public Sector (Medicaid/Medicare) services and HCPC codes/services.
• Clinical experience with Substance Abuse diagnoses.

Schedule

This is a full-time salaried position requiring availability Monday through Friday, 8:30 AM to 5:00 PM CST. If located in Florida, you will have the flexibility to work remotely.

Pay

The salary for this role ranges from $91,700 to $163,700 annually based on full-time employment, depending on factors such as local labor markets, education, work experience, and certifications.

Benefits

In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).