Prior Authorization Psychiatrist (Part-Time Contractor)

Gainwell Technologies LLC•Any city, OH

1d•$234,000 - $280,000•Remote

About The Position

As a Prior Authorization Physician, you will provide medical expertise and clinical oversight in support of utilization management and prior authorization activities within a Medicaid-focused healthcare environment. This remote, part-time contractor role is responsible for reviewing medical necessity requests, evaluating clinical documentation, and ensuring care decisions are evidence-based, appropriate, and aligned with established program guidelines. In this role, you will help improve healthcare quality and access by applying clinical expertise to utilization management decisions and supporting medically necessary, cost-effective care for members.

Requirements

Medical degree (MD or DO) with a specialty in Psychiatry.
Unrestricted license to practice medicine in the United States.
Physically located in the United States.
Post-graduate experience in direct patient care.
Prior Authorization and/or Utilization Review experience, preferably within Medicaid or managed care environments.
Experience providing clinical oversight and medical leadership.
Knowledge of Medicaid and healthcare utilization management.
Strong clinical judgment and decision-making skills.
Excellent verbal and written communication skills.
Ability to interpret complex clinical, regulatory, and procedural documents.
Strong analytical, organizational, and time management skills.
Proficiency with standard computer applications.
Ability to work independently and collaborate effectively across teams.
Candidates must be located within the United States while performing work.

Responsibilities

Serving as a clinical subject matter expert for staff, leadership, clients, and providers.
Conducting medical necessity reviews for requested services, medications, and procedures using established clinical criteria.
Participating in peer-to-peer discussions with providers to support informed clinical decisions.
Reviewing complex clinical cases, documentation, and healthcare-related issues.
Assisting with utilization management activities and medically complex claim reviews.
Interpreting clinical, regulatory, and procedural guidelines to support accurate decision-making.
Collaborating with cross-functional teams to improve program effectiveness, quality outcomes, and access to care.
Participate in the appeals process where indicated.