Internal Medicine Or Family Practice Physician Reviewer

Found in: beBee jobs US - 2 weeks ago


Lombard, Illinois, United States KEPRO Full time

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise.Acentra seeks an Internal Medicine or Family Practice Physician Reviewer (Illinois Remote, PRN) to join our growing team.The Internal Medicine or Family Practice 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.Conducts phone consultations with various Illinois hospitals to establish medical necessity and continued stay criteria for IL Medicaid Fee-For-Service beneficiaries.Analyze and remain current on national, state, and local regulations and legislation which impact the healthcare profession.Board Certification in Internal Medicine or Family Medicine.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 programs.


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