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Pediatric Physician Reviewer - PRN (Remote Illinois)

LocationLombard Illinois United States
Salary
Remote🌴Remote allowed
First listedIn the last 4 months

Job Description

Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.

Pediatric Physician Reviewer (PRN) - Remote

  • Are you an experienced Physician Reviewer looking for a new challenge?
  • Are you looking to join a team that ensures a collaborative and inviting culture where everyone can thrive?

This is a PRN opportunity to work remotely in Illinois.

The selected candidate must possess an active Illinois MD/DO License.

If so, you might be our next new team member!

Who we need:

A Pediatric Physician Reviewer who will provide principal leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring clinical leadership and consultation. Conducts phone consultations with various Illinois hospitals to establish medical necessity and continued stay criteria for IL Medicaid Fee-For-Service beneficiaries.

Why us?

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.

Singularly Focused. Mission Driven.

Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

What you’ll do:

  • 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 Acentra Health at seminars, professional societies, medical staff meetings, and other professional settings as appropriate.

What you’ll need:

Required Qualifications

  • Licensed Physician (MD/DO) to practice in all branches in Illinois.
  • Board Certification in Pediatrics.
  • Engaged in active practice.
  • Has admitting or staff privileges in one or more Illinois hospitals or state facilities.

Knowledge, Skills, Abilities

  • Knowledge of the American Board of Pediatrics (ABP) established standards.
  • Knowledge of Medicaid programs with relevant experience navigating similar complex projects.
  • Knowledge of standards of practice related to the determination of level of care.
  • Knowledge of standards of practice related to diagnosis and treatment of acute and chronic diseases in children from birth to young adulthood, typically requiring inpatient admission.
  • Knowledge and understanding of public sector services and supports.
  • Computer proficiency in Microsoft Excel, Word, PowerPoint, Teams, and Outlook.
  • 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 evaluations.

Experience

  • Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare programs.

Thank You!

We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.

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