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Internal Medicine or Family Practice Physician Reviewer

2 months ago

Lombard, United States Acentra Health Full time

CNSI and Kepro are now Acentra Health 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 company's mission, actively engage in problem-solving, and take ownership of your work daily. 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 an Internal Medicine or Family Practice Physician Reviewer (Illinois Remote, PRN) to join our growing team.

Job Summary:

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.

*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.
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 nationwide. Our company cares about our employees, giving 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 interest you. Best of luck in your search

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE 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.

Requirements
  • Licensed Physician (MD/DO) to practice in all branches in Illinois.
  • Board Certification in Internal Medicine or Family Medicine.
  • 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 programs.
  • 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.

Benefits

Compensation

The pay rate for this position is $125 per hour.

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