[Hiring] Psychiatrist @Acentra Health, LLC

Role Description

Acentra Health is looking for a Psychiatrist (PRN) / Claims Reviewer to join our growing team. The primary responsibilities include:

• Conducting independent medical service appeal reviews
• Providing expert testimony
• Ensuring compliance with guidelines

The position is remote and requires a M.D. or D.O. license to practice in the State of Maine.

Job Responsibilities:

• Prepare independent reviews of behavioral health services appeals
• Review records, prepare and submit all reviews in keeping with the Acentra Health contractual due dates
• Critically evaluate the application of guidelines and protocols by managed care organizations, dental benefits manager, and pharmacy benefits manager
• Consider Rules of Medical Necessity, standards of care, evidence-based medicine, and hierarchy of evidence
• Review relevant peer-reviewed research and evidence-based sources as needed
• Edit Medical Necessity Reviews authored by other reviewers
• Provide expert medical witness testimony for the State in appeals hearings
• Consult with the assigned attorney prior to the hearing as needed
• Participate in quality assurance activities for medical necessity reviews and hearing outcomes
• Regularly review relevant topics via peer-reviewed articles and evidence-based sources
• Work with medical, nursing, and administrative staff to identify matters needing shared attention
• May primarily work remotely but must be available onsite to the client as contractually required
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules
• The list of responsibilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time

Qualifications

• M.D. or D.O., with current non-restricted license to practice medicine by the Board of Medical Examiners in the State of Maine
• Must have Utilization Review experience in Behavioral Health Services
• Working knowledge of quality assurance and utilization review is required
• 3+ years of clinical practice
• Experience with Medicaid

Requirements

• Ability to work effectively with a diversity of personalities
• Must be approachable, show respect for others, and a consensus builder
• Adaptable with strong collaborative management style
• Creative thinker with high energy and enthusiasm
• Team player who promotes the concepts of people working together
• Excellent writing skills and proficient with MS Office Suite

Benefits

• Retirement savings
• Corporate wellness
• Educational assistance
• Corporate discounts
• Additional protection, security, and support for both your career and your life away from work