Psychiatrist (PRN)

Acentra Health; United States; Remote; USD 138,000 - 248,000; Full time

Job summary

Acentra Health is seeking a Psychiatrist (PRN) / Claims Reviewer to join our team. The role involves independent reviews of behavioral health services appeals, providing expert testimony, and ensuring compliance with guidelines.

The position is remote but requires Maine license and onsite availability as contractually required. Applicants should have an MD/DO, Utilization Review experience in Behavioral Health, and at least 3 years of clinical practice, with Medicaid experience preferred.

Qualifications

• MD or DO with current non-restricted license to practice medicine in Maine.
• Utilization Review experience in Behavioral Health Services.
• Working knowledge of quality assurance and utilization review.
• 3+ years of clinical practice; Medicaid experience.

Responsibilities

• Prepare independent reviews of behavioral health services appeals.
• Review records and submit reviews by contractual due dates.
• Critically evaluate guideline application against standards of care and evidence.
• Review relevant peer reviewed research as needed.
• Edit Medical Necessity Reviews authored by other reviewers.
• Provide expert medical witness testimony for state appeals and consult with lawyers.
• Participate in quality assurance activities for medical necessity reviews and outcomes.
• Read and stay updated on changes in medical practice, treatments, and medications.
• May work remotely but must be available onsite to the client as required.

Skills

Utilization review

Behavioral health

Quality assurance

Education

MD/DO with Maine license

Tools

MS Office Suite

Job description

Acentra Health is looking for a Psychiatrist (PRN) / Claims Reviewer to join our growing team.

Job Summary:

The primary responsibilities of a Psychiatrist (PRN) / Claims Reviewer include conducting independent medical service appeal reviews, providing expert testimony, and ensuring compliance with guidelines. The position is remote and requires a M.D. or D.O. license to practice in the State of Maine.

Job Responsibilities:

• Prepare independent reviews of behavioral health services appeals
• Review records, prepare and submit all reviews in keeping with the Acentra Health contractual due dates. These may include appeals by members and other key stakeholders.
• Critically evaluate the application of guidelines and protocols by managed care organizations, dental benefits manager, and pharmacy benefits manager to the individual enrollee's appeal. Take into consideration Rules of Medical Necessity, standards of care, evidence-based medicine, and hierarchy of evidence.
• Review relevant peer reviewed research and evidence-based sources as needed
• Edit Medical Necessity Reviews authored by other reviewers
• Provide expert medical witness testimony for the State in appeals hearings and consult with the assigned attorney prior to the hearing as needed
• Participate in quality assurance activities for medical necessity reviews and hearing outcomes
• Regularly review relevant topics via peer reviewed articles and evidence-based sources to identify changes in medical practice, treatments, and medications
• Work with medical, nursing, and administrative staff to identify matters needing shared attention
• May primarily work remotely but must be available onsite to the client as contractually required
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
• The list of responsibilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to day.

Required Qualifications

• M.D. or D.O., with current non-restricted license to practice medicine by the Board of Medical Examiners in the State of Maine.
• Must have Utilization Review experience in Behavioral Health Services.
• Working knowledge of quality assurance and utilization review is required.
• 3+ years of clinical practice.
• Experience with Medicaid

Preferred Qualifications

• Ability to work effectively with a diversity of personalities. Must be approachable, show respect for others, and a consensus builder.
• Adaptable with strong collaborative management style, a creative thinker with high energy and enthusiasm, and a team player who promotes the concepts of people working together.
• Excellent writing skills and proficient with MS Office Suite

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health. Best of luck in your search!

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation: $100-$180 per hour

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."