Peer Review Psychiatrist

As a Peer Review Psychiatrist, you will conduct peer reviews and appeals to ensure the level of care is appropriate and necessary for Concurrent Acute Inpatient Psychiatric requests. Candidate must possess a California medical license with a psychiatry specialty. \n What you'll do: Evaluate Care Quality: Perform peer reviews to ensure healthcare services meet necessity and appropriateness standards Manage Contract Reviews: 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 Required Skills and Experience: 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 Preferred Skills and Experience: Mastery of DSM-5 and ICD-10 criteria to accurately evaluate complex mental health conditions Deep understanding of psychiatric medications, side effects, and evidence-based treatment algorithms Comfort with electronic health records (EHRs) and utilization review software Familiarity with state and federal guidelines, HIPAA compliance, and insurance or Medicaid-specific medical necessity criteria Skill in conducting conversations clearly, professionally, and respectfully with treating clinicians Capacity to write clear, concise, and evidence-based rationales for decisions or quality evaluations \n Who We Are: Telligen is one of the most respected population health management organizations in the country. We offer clinical, analytical, and technical expertise to support local, Tribal, and national partners, state and federal government programs, and employers and health plans. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we’re seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health. Are you Ready? We’re on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success. Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are. Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives. Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen! Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms. Telligen is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, protected veteran status, disability or any other protected class. Telligen is committed to ensuring that our employment process is open to all individuals, and provides reasonable accommodations to individuals who need assistance during any part of the employment process due to a disability, medical condition, or physical or mental impairment. Reasonable accommodations are considered on a case-by-base basis. If you need assistance to navigate Telligen’s careers website or to apply for a position, please send an email to [email protected]

The Peer Review Psychiatrist conducts peer reviews and appeals to ensure the necessity and appropriateness of Concurrent Acute Inpatient Psychiatric requests. They also serve as a subject matter expert on review processes and articulate company policies to various stakeholders.

Candidates must hold an active, unrestricted California medical license and be board-certified in Psychiatry or Neurology. A proven background in utilization management and familiarity with medical necessity criteria like MCG or InterQual are required.

• Employee-owned company

Relevées dans la description du poste. Confirmez les exigences importantes ci-dessus.

• Psychiatry
• Utilization management
• Peer review
• Clinical practice
• MCG
• InterQual
• DSM-5
• ICD-10
• Psychiatric medications
• Evidence-based treatment
• Electronic health records
• HIPAA compliance
• Medicaid
• Medical necessity criteria
• Ingenuity
• Treatment Algorithms
• Board Certified In Psychiatry
• Peer Review
• Mental Health
• Management
• Clinical Practices
• Diagnostic And Statistical Manual Of Mental Disorders
• Economics
• Electronic Medical Record
• ICD Coding (ICD-9/ICD-10)
• Innovation
• Medical License
• Medical Necessity
• Neurology
• Population Health
• Psychiatric Medications
• Utilization Management
• Contract Review

• Healthcare
• Consulting
• Government & Public Sector
• Psychiatrist
• Specialist Medical Practitioners
• Psychiatrists

Formation minimale

Maîtrise

Expérience minimale

5+ ans

Langue de l’offre

anglais

Heures de travail

40 heures par semaine