Remote Psychiatrist & Medical Necessity Reviewer

Acentra Health, LLC; Maine; Remote; USD 121,000 - 193,000; Full time

Job summary

Acentra Health is seeking a Psychiatrist (PRN) / Claims Reviewer in Maine. The role focuses on independent medical service appeal reviews, expert testimony, and adherence to guidelines.

License to practice in Maine (MD or DO) is required, and the position is primarily remote with occasional onsite client visits. Responsibilities include evaluating records, applying standards of medical necessity, and coordinating with legal teams.

Qualifications

• MD or DO with a current non-restricted license in Maine.
• Utilization Review experience in Behavioral Health is required.
• Knowledge of quality assurance and utilization review processes.
• Experience with Medicaid is desirable.

Responsibilities

• Prepare independent reviews of behavioral health services appeals.
• Provide expert medical testimony for hearings and coordinate with counsel.
• Ensure compliance with guidelines and HIPAA/privacy rules.
• Review records and adhere to contractually required due dates.
• May work remotely but must be available onsite when required.

Skills

Utilization Review

Quality Assurance

Medicaid Experience

Education

MD/DO with Maine license

Job description

Acentra Health is seeking a Psychiatrist (PRN) / Claims Reviewer in Maine. The role focuses on independent medical service appeal reviews, expert testimony, and adherence to guidelines.

License to practice in Maine (MD or DO) is required, and the position is primarily remote with occasional onsite client visits. Responsibilities include evaluating records, applying standards of medical necessity, and coordinating with legal teams.