Psychiatrist, Clinical Reviews, Addiction Medicine, Telecommute
(AZ or CA state licensure preferred)
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)
- You will be responsible for clinical peer review of current inpatient services and intensive mental health and substance abuse services to review medical appropriateness
- Works with OrthoNet staff to coordinate all the necessary UM processes and provides feedback to OrthoNet staff who do portions of the UM reviews
- Perform individual case reviews for appeals and grievances for various Abuse and Medical Detox facilities
- Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
- Discusses cases and clinical situations with treating providers telephonically during scheduled hours Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
- Composes, if needed, patient situation specific, clinical summaries and rationales for medical necessity decisions
- Is available for occasional, periodic weekend and holiday as needed telephonic and remote computer appeals and expedited clinical decisions
- Supports compliance with regulatory agency standards and requirements (i.e. HCFA, NCQA, URAC, state / federal and third party payors)
- Perform all other duties as assigned
- Ability to work remotely from an OrthoNet clinical site by computer
- Flexible availability on a pre-arranged basis to assist in coverage of cases according to regulatory timeframes
- Ability to be available for pre-planned blocks of time to assure proper coverage of business requirements
- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) Required
- Specialty certification (child and adolescent psychiatry, or substance use disorders) not required but desirable
- 5+ years clinical practice experience
- A Minimum of 1 year of experience performing clinical chart reviews for Addiction Medicine
- Working knowledge of InterQual criteria,desired
- Managed care experience desirable
- Exceptional writing skills, with a strong attention to detail
- Excellent telephonic communication skills; excellent interpersonal communication skills
- Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills
- Current Arizona or California State license
UnitedHealth Group is working to create the health care system of tomorrow.
Already Fortune 14, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.
Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.
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.
Sorry,this is NOT an opportunity for Search Firm recruiters.