Peer Review Psychiatrist

Telligen

3d

About The Position

As a Peer Review Psychiatrist, you will conduct peer reviews and appeals to ensure the level of care is appropriate and necessary for Concurrent Acute Inpatient Psychiatric requests. Candidate must possess a California medical license with a psychiatry specialty.

Requirements

• Active, unrestricted medical license in California (or willingness to obtain) and the contracted state
• Board certification in Psychiatry or Neurology by a US board (active and unrestricted)
• Proven background in utilization management and several years of hands-on clinical practice
• Working knowledge of MCG or InterQual medical necessity criteria

Nice To Haves

• Mastery of DSM-5 and ICD-10 criteria to accurately evaluate complex mental health conditions
• Deep understanding of psychiatric medications, side effects, and evidence-based treatment algorithms
• Comfort with electronic health records (EHRs) and utilization review software
• Familiarity with state and federal guidelines, HIPAA compliance, and insurance or Medicaid-specific medical necessity criteria
• Skill in conducting conversations clearly, professionally, and respectfully with treating clinicians
• Capacity to write clear, concise, and evidence-based rationales for decisions or quality evaluations

Responsibilities

• Perform peer reviews to ensure healthcare services meet necessity and appropriateness standards
• Direct medical review activities across assigned contracts
• Serve as the subject matter expert on peer review processes
• Articulate Telligen’s policies to diverse medical and non-medical audiences

Benefits

• 100% employee-owned company

What This Job Offers

• Job Type: Full-time
• Career Level: Senior