Psychiatrist – Clinician Leader in Medicaid Utilization

Acentra; Indiana; On-site; USD 121,000 - 207,000; Full time

Job summary

Acentra Health is seeking a Psychiatrist to join our growing team. The Psychiatrist provides clinical leadership for peer and utilization review activities and conducts essential phone consultations with the State psychiatric hospitals to determine the medical necessity for Medi-Cal beneficiaries.

The role requires collaboration with leadership to report provider trends, ensure compliance with regulatory requirements, and represent the organization at professional meetings and seminars.

Qualifications

• Licensed Psychiatrist (MD/DO) 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

Board Certification

Education

Licensed Psychiatrist (MD/DO) in Indiana

Board Certification

Job description

Acentra Health is seeking a Psychiatrist to join our growing team. The Psychiatrist provides clinical leadership for peer and utilization review activities and conducts essential phone consultations with the State psychiatric hospitals to determine the medical necessity for Medi-Cal beneficiaries.

The role requires collaboration with leadership to report provider trends, ensure compliance with regulatory requirements, and represent the organization at professional meetings and seminars.