Utilization Review Psychiatrist - Medicaid Expert

Acentra Health, LLC; Indianapolis (IN); On-site; USD 122,000 - 207,000; Full time

Benefits offered by this job

401(k) Plan with company match

Wellness programs

Employee discount programs

Employee Assistance Program (EAP)

Job summary

Acentra Health is seeking a Psychiatrist to join our team in Indiana. The role provides clinical leadership for peer and utilization review activities and conducts critical phone consultations to determine medical necessity for Medi-Cal beneficiaries.

The position requires Indiana licensed psychiatrists, board certification, and experience in utilization management, with exposure to Medicaid/Medicare programs. Flexible benefits and compliance with HIPAA are emphasized.

Qualifications

• Licensed psychiatrist in Indiana with active license.
• Board certification required.
• Experience in utilization management.
• Knowledge of Medicaid/Medicare programs.

Responsibilities

• Provide clinical leadership for peer and utilization review activities.
• 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 HIPAA and its Privacy and Security Rules.

Skills

Licensed Psychiatrist (MD/DO)

Board Certification

Utilization Management

Medicaid/Medicare knowledge

Job description

Acentra Health is seeking a Psychiatrist to join our team in Indiana. The role provides clinical leadership for peer and utilization review activities and conducts critical phone consultations to determine medical necessity for Medi-Cal beneficiaries.

The position requires Indiana licensed psychiatrists, board certification, and experience in utilization management, with exposure to Medicaid/Medicare programs. Flexible benefits and compliance with HIPAA are emphasized.