Peer Review Psychiatrist

This is a fully remote position, open to applicants in Idaho, +5 more states.

📋 Description

• Carry out peer reviews and appeals for Concurrent Acute Inpatient Psychiatric requests

• Assess healthcare services to verify medical necessity, appropriateness, and compliance with quality standards

• Oversee medical review operations across designated contracts

• Act as the subject matter expert on peer review procedures

• Communicate Telligen’s policies to varied medical and non-medical audiences

⛳️ Requirements

• Active, unrestricted medical license in California (or willingness to obtain) and in the contracted state

• Board certification in Psychiatry or Neurology by a US board (active and unrestricted)

• Established experience in utilization management and multiple years of direct clinical practice

• Familiarity with MCG or InterQual medical necessity criteria

• Proficiency in DSM-5 and ICD-10 criteria preferred

• Strong knowledge of psychiatric medications, their side effects, and evidence-based treatment algorithms preferred

• Comfort with electronic health records and utilization review software preferred

• Awareness of state and federal regulations, HIPAA compliance, and insurance or Medicaid-specific medical necessity criteria preferred

• Ability to communicate clearly, professionally, and respectfully with treating clinicians preferred

• Capacity to draft clear, concise, evidence-based rationales preferred

🏝️ Benefits

• 100% employee-owned company with employee-owners benefiting from company success

• Equal opportunity employer

• Reasonable accommodations provided during the employment process

• Mission-driven, inclusive, and collaborative work environment