Job Information
KEPRO Physician Reviewer MD/DO - CA Licensed Psychiatrist - PRN (Remote U.S.) in United States
CNSI and Kepro are now Acentra Health! 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 company’s mission, actively engage in problem-solving, and take ownership of your work daily. 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.
Acentra seeks a Physician Reviewer MD/DO (CA Licensed Psychiatrist) - PRN to join our growing team.
Job Summary:
A Physician Reviewer who 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. Conducts phone consults with various California psychiatric hospitals to establish medical necessity and continued stay criteria for Medi-Cal 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 that impact the healthcare profession.
As appropriate, represent and promote Acentra Health at seminars, professional societies, medical staff meetings, and other professional settings.
Requirements
Required Qualifications/Experience:
Licensed Psychiatrist (MD/DO) in the state of California.
Board Certification.
Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare programs.
Preferred Qualifications/Experience:
Knowledge of Parity in Mental Health and Substance Use Disorder Services Final Rule (Parity Rule; Title 42 of the CFR, part 438.910)
Knowledge of Medicaid programs with relevant experience navigating similar complex projects.
Knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual in use in California.
Knowledge of standards of practice related to the determination of level of care.
Knowledge of standards of practice related to mental health and other disorders typically requiring psychiatric inpatient.
Knowledge and understanding of public sector services and supports.
Computer proficiency in Microsoft Excel, Word, PowerPoint, Teams, and Outlook.
Ability to determine a clinical diagnosis accounting for psychological and behavioral issues.
Ability to utilize computer equipment and web-based software to conduct work.
Ability to interact with various office staff as needed to support necessary workflows.
Ability to interact with healthcare professionals, patients, their families, and other supports.
Ability to communicate effectively to individuals and groups through spoken, written, and electronic media.
Ability to attend to detail, effectively prioritize, and execute tasks in a timely manner.
Assess and analyze psychological, emotional, behavioral, and physical functioning.
Develop the level of care recommendations based on clinical evaluations.
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 nationwide. Our company cares about our employees, giving you the tools and encouragement you need to achieve the finest work of your career.
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 and invite you to apply to future openings that may interest you. Best of luck in your search!
The Acentra Health Talent Acquisition Team
Visit us at Acentra.com/careers/
EOE 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, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.
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Benefits
Compensation
The pay range for this position is $175.00 per hour.
“Based on our compensation philosophy, an applicant’s placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”