Clinical Leader for Utilization Review
4 weeks ago
We are seeking a highly skilled Clinical Leader to join our team as a Psychiatrist Physician Reviewer. This is a unique opportunity to work with a leading healthcare organization, CNSI, and contribute to the development of innovative health solutions.
**Job Summary**
As a Clinical Leader, you will be responsible for providing principal leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring clinical leadership and consultation. You will conduct phone consultations with various Illinois hospitals to establish medical necessity and continued stay criteria for IL Medicaid Fee-For-Service beneficiaries.
**Key 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 CNSI at seminars, professional societies, medical staff meetings, and other professional settings as appropriate.
**Requirements**
* Licensed Psychiatrist (MD/DO) to practice in all branches in Illinois.
* Board Certification.
* Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare programs.
* Engaged in active practice.
* Have admitting or staff privileges in one or more Illinois hospitals or state facilities.
**What We Offer**
* Competitive compensation package.
* Opportunities for professional growth and development.
* Collaborative and dynamic work environment.
**How to Apply**
If you are a motivated and experienced Clinical Leader looking for a new challenge, please submit your application. We look forward to hearing from you.
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