Peer Reviewer - 1099 Consultant - Remote

Overview

As a Peer Reviewer -1099 Consultant, you will leverage your medical knowledge and deep understanding of mental health and substance abuse disorders, diagnosis, and standards of care to determine medical necessity and appropriate care for Medicaid beneficiaries.

In Short

• Conduct critical peer reviews to ensure the healthcare given is appropriate and necessary.
• Focus on psychiatric and addiction medicine reviews.
• Oversee medical review activities for the assigned contract.
• Serve as a technical expert on the peer review process.
• Represent Telligen policies and procedures to medical and non-medical persons.
• Participate in committee meetings as a representative of Telligen.

Requirements

• Current unrestricted clinical license to practice medicine in the contracted state, or willingness to obtain licensure in the state.
• For WY Must be a Board-Certified Child/Adolescent Psychiatrist.
• Current and active, unrestricted United States board certification in Psychiatry/Neurology.
• Certified Addiction Medicine Physicians are also highly desired.
• Utilization Management experience.
• Familiarity with MCG or InterQual medical necessity guidelines or ASAM criteria.
• Board-Certified Child/Adolescent Psychiatrist preferred.

Benefits

• Flexible working hours.
• Opportunity to work with a leading healthcare organization.
• Ability to influence healthcare quality for Medicaid beneficiaries.