Peer Reviewer: Doctorate Level Licensed Psychologist!
UnitedHealth Group - St. Louis, MO

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Licensed Doctorate Level Psychologist! Intensive Outpatient!

In this position, the Peer Reviewer will report up through the ALERT outpatient program. The ALERT peer reviewer will be responsible for conducting peer to peer clinical reviews of IOP (intensive outpatient cases) where the patient's length of stay exceeds normative standards, and/or the patient's care cannot be authorized by a care advocate. The ALERT peer reviewer will be responsible for applying medical necessity criteria to these cases resulting in the authorization of continued treatment if medically necessary, authorization of a modified treatment plan as appropriate, or issuance of an adverse benefit determination if indicated.

Responsibilities:
Performing peer to peer reviews regarding patient levels of care

Working with denials and appeals

Consulting with providers

Advises leadership on improvement opportunities regarding medical expense programs and clinical activities that impact medical expenses

Develops innovative approaches and sought out as an expert

Serves as a leader/ mentor

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