Job Description

Psychiatrist Physician Reviewer - PRN - Remote (Within Illinois)

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Description

Acentra seeks a Psychiatrist Physician Reviewer (PRN) to join our growing team.

Job Summary:

The Psychiatrist Physician Reviewer will provide principal leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring clinical leadership and consultation. They will conduct phone consultations with various Illinois hospitals to establish medical necessity and continued stay criteria for IL Medicaid Fee-For-Service beneficiaries.

Job Responsibilities:

• Conduct peer-to-peer physician consultations as requested/required and document consultations
• Provide clinical expertise with respect to planning and establishing goals and policies to improve clinical operations
• Represent the organization through state appeal processes
• Review medical information trends, experiences, and approaches and assist in the development of strategic plans for clinical improvements
• Provide program representation at stakeholder engagement meetings
• Ensure compliance with regulatory and accreditation requirements
• Analyze and remain current on national, state, and local regulations and legislation which impact the healthcare profession
• Represent and promote Acentra Health at seminars, professional societies, medical staff meetings, and other professional settings as appropriate
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

Qualifications

Required Qualifications

• Licensed Physician (MD/DO) to practice in all branches in Illinois
• Board Certification in Psychiatry
• Engaged in active practice
• Have admitting or staff privileges in one or more Illinois hospitals or state facilities
• Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare program
• Knowledge of standards of practice related to the determination of level of care
• Knowledge of Medicaid programs with relevant experience navigating similar complex projects
• Computer proficiency in Microsoft Excel, Word, PowerPoint, Teams, and Outlook

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