State Licensed Psychiatry Reviewer
Job Summary
Working remotely on a part-time basis, the State Licensed Psychiatry Reviewer will provide timely medical reviews of service requests that do not initially meet medical necessity guidelines, interacting with physicians and health plan members as needed.
Key responsibilities
- Reviews cases requiring clinical determinations beyond the Initial Clinical Reviewer's assessments
- Discusses determinations with requesting physicians and provides clinical rationale for appeals
- Ensures accurate documentation of communications with medical staff and participates in inter-rater reliability training
Required qualifications
- Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), or equivalent international degree with U.S. internship and residency completion
- Current, unrestricted medical license in one or more U.S. states
- Board Certification by an appropriate medical board
- At least 1 year of work experience in clinical review
- Eligibility to work in the U.S. without visa sponsorship
Complete Job Description
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