Peer Review Psychiatrist

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🥔 Idaho, Iowa, +4 more states – Remote

🥔 Idaho – Remote 🌾 Iowa – Remote 🦬 Montana – Remote 🌪️ Oklahoma – Remote 🎸 Mississippi – Remote 🦬 Wyoming – Remote

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

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Telligen

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1978

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Telligen is a trusted partner for U. S. government health agencies, state Medicaid agencies, self-funded employer and Taft-Hartley health plans, and managed care organizations. The company aims to improve health outcomes for millions of people nationwide through proven health management solutions and healthcare expertise. Telligen provides quality improvement, data analytics, quality measures, program management, and health information technology solutions to federal and state health agencies and national programs. It also offers utilization management, care management, and wellness solutions for health plans and employers. Their work includes efforts as a Quality Innovation Network-Quality Improvement Organization and a Hospital Quality Improvement Contractor across multiple states. Telligen has received Population Health Program Accreditation for its expertise in population health management.

📋 Description

• Conduct peer reviews and appeals for Concurrent Acute Inpatient Psychiatric requests • Evaluate healthcare services to ensure medical necessity, appropriateness, and quality standards • Direct medical review activities across assigned contracts • Serve as the subject matter expert on peer review processes • Articulate Telligen’s policies to diverse medical and non-medical audiences

🎯 Requirements

• Active, unrestricted medical license in California (or willingness to obtain) and the contracted state • Board certification in Psychiatry or Neurology by a US board (active and unrestricted) • Proven background in utilization management and several years of hands-on clinical practice • Working knowledge of MCG or InterQual medical necessity criteria • Mastery of DSM-5 and ICD-10 criteria preferred • Deep understanding of psychiatric medications, side effects, and evidence-based treatment algorithms preferred • Comfort with electronic health records and utilization review software preferred • Familiarity with state and federal guidelines, HIPAA compliance, and insurance or Medicaid-specific medical necessity criteria preferred • Clear, professional, and respectful communication with treating clinicians preferred • Ability to write clear, concise, evidence-based rationales preferred

🏖️ Benefits

• 100% employee-owned company with employee-owners sharing in company success • Equal opportunity employer • Reasonable accommodations during the employment process • Mission-driven, inclusive, and collaborative work environment