Remote Case Reviewer Jobs in Winfield, IL (NOW HIRING)

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Psychiatrist Physician Reviewer (PRN) to join our growing team.

Job Summary:

The Psychiatrist Physician Reviewer will provide principal leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring clinical leadership and consultation. They will conduct phone consultations with various Illinois hospitals to establish medical necessity and continued stay criteria for IL Medicaid Fee-For-Service beneficiaries.

*Position is PRN and remote within the state of Illinois.

Job Responsibilities:   

• Conduct peer-to-peer physician consultations as requested/required and document consultations
• Provide clinical expertise with respect to planning and establishing goals and policies to improve clinical operations
• Represent the organization through state appeal processes
• Review medical information trends, experiences, and approaches and assist in the development of strategic plans for clinical improvements
• Provide program representation at stakeholder engagement meetings
• Ensure compliance with regulatory and accreditation requirements
• Analyze and remain current on national, state, and local regulations and legislation which impact the healthcare profession
• Represent and promote Acentra Health at seminars, professional societies, medical staff meetings, and other professional settings as appropriate
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

Required Qualifications

• Licensed Physician (MD/DO) to practice in all branches in Illinois
• Board Certification in Psychiatry
• Engaged in active practice
• Have admitting or staff privileges in one or more Illinois hospitals or state facilities
• Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare program
• Knowledge of standards of practice related to the determination of level of care
• Knowledge of Medicaid programs with relevant experience navigating similar complex projects
• Computer proficiency in Microsoft Excel, Word, PowerPoint, Teams, and Outlook

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is $70.97-125.00 per hour.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."