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Clinical Leader

4 weeks ago

Lombard, Illinois, United States CNSI Full time
Job Title: Clinical Leader

Company Description: CNSI and Kepro are now Acentra Health, a company that empowers better health outcomes through technology, services, and clinical expertise.

Our mission is to innovate health solutions that deliver maximum value and impact.

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.

Job Responsibilities:
  • Conduct peer-to-peer physician consultations as requested/required and document clinical expertise with respect to planning and establishing goals and policies to improve clinical 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
Qualifications:
  • Licensed Psychiatrist (MD/DO) to practice in all branches in Illinois.
  • Board 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.
  • Knowledge, Skills, Abilities
  • Knowledge of Parity in Mental Health and Substance Use Disorder Services Final Rule (Parity Rule; Title 42 of the CFR, part Knowledge of Medicaid programs with relevant experience navigating similar complex projects.
  • Knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual in use in Illinois.
  • Knowledge of standards of practice related to the determination of level of care.
  • Knowledge of standards of practice related to mental health and other disorders typically requiring psychiatric and understanding of public sector services and supports.
  • Computer proficiency in Microsoft Excel, Word, PowerPoint, Teams, and Outlook.
  • Ability to determine a clinical diagnosis accounting for psychological and behavioral issues.
  • Ability to utilize computer equipment and web-based software to conduct work.
  • Ability to interact with various office staff as needed to support necessary workflows.
  • Ability to interact with healthcare professionals, patients, their families, and other supports.
  • Ability to communicate effectively to individuals and groups through spoken, written, and electronic media.
  • Ability to attend to detail, effectively prioritize, and execute tasks in a timely manner.
  • Assess and analyze psychological, emotional, behavioral, and physical functioning.
  • Develop the level of care recommendations based on clinical pay rate for this position is $125 / hour.