Prior Authorization Psychiatrist – Part-Time Contractor

🔥 13 hours ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $234k - $280k / year

⏱ Part Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Serve as a clinical subject matter expert for staff, leadership, clients, and providers • Conduct medical necessity reviews for requested services, medications, and procedures using established clinical criteria • Participate in peer-to-peer discussions with providers • Review complex clinical cases, documentation, and healthcare-related issues • Assist with utilization management activities and medically complex claim reviews • Interpret clinical, regulatory, and procedural guidelines to support accurate decision-making • Collaborate with cross-functional teams to improve program effectiveness, quality outcomes, and access to care • Participate in the appeals process where indicated • Provide medical expertise and clinical oversight for utilization management and prior authorization activities in a Medicaid-focused healthcare environment

🎯 Requirements

• Medical degree (MD or DO) with a specialty in Psychiatry • Unrestricted license to practice medicine in the United States • Physically located in the United States • Post-graduate experience in direct patient care • Prior Authorization and/or Utilization Review experience, preferably within Medicaid or managed care environments • Experience providing clinical oversight and medical leadership • Knowledge of Medicaid and healthcare utilization management • Strong clinical judgment and decision-making skills • Excellent verbal and written communication skills • Ability to interpret complex clinical, regulatory, and procedural documents • Strong analytical, organizational, and time management skills • Proficiency with standard computer applications • Ability to work independently and collaborate effectively across teams • Candidates must be located within the United States while performing work

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Flexible vacation policy (eligible salaried, full-time candidates) • 401(k) employer match (eligible salaried, full-time candidates) • Comprehensive health benefits (eligible salaried, full-time candidates) • Educational assistance (eligible salaried, full-time candidates) • Leadership and technical development academies • Remote work flexibility