Psychiatrist – Clinical Leader in Utilization & Medicaid

Acentra; United States; On-site; USD 122,000 - 207,000; Full time

Benefits offered by this job

401(k) Plan with company match

Wellness programs

Employee Assistance Program (EAP)

Job summary

Acentra Health in the United States is seeking a licensed Psychiatrist to provide clinical leadership for peer and utilization review activities within the company. You will conduct essential phone consultations with state psychiatric hospitals to determine medical necessity for Medicaid beneficiaries.

This role requires board certification and strong knowledge of Medicaid/Medicare programs, with duties including reviews, peer-to-peer consultations, regulatory compliance, and representing the

Qualifications

• Licensed Psychiatrist (MD/DO) licensed in Indiana.
• Board Certification required.
• Experience in Utilization Management.
• Knowledge of Medicaid and Medicare programs.

Responsibilities

• Conduct medical necessity reviews for state Medicaid plan using federal, state, and nationally recognized criteria along with clinical expertise.
• Conduct peer-to-peer consultations between physicians and document the consultations as needed.
• Represent the organization in state appeal processes as needed.
• Partner with leadership to report provider trends noticed in case documentation.
• Ensure compliance with regulatory and accreditation requirements.
• Promote the organization at professional meetings and seminars.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Skills

Utilization Management

Medicaid knowledge

Medicare knowledge

Attention to detail

Education

MD/DO Licensed in Indiana

Board Certification

Job description

Acentra Health in the United States is seeking a licensed Psychiatrist to provide clinical leadership for peer and utilization review activities within the company. You will conduct essential phone consultations with state psychiatric hospitals to determine medical necessity for Medicaid beneficiaries.

This role requires board certification and strong knowledge of Medicaid/Medicare programs, with duties including reviews, peer-to-peer consultations, regulatory compliance, and representing the