1099 Physician Reviewer- Psychologist
Iowa
State Health Solutions /
1099 Consultant /
Hybrid
This position is primarily responsible for conducting medical necessity reviews, as well as appeals and peer to peer discussions across the business unit portfolio of contracts. The incumbent is responsible for completing all reviews and appeals within contractually determined timelines, collaborating with clinical reviewers, providing consultation on clinical decision-making. This work is estimated to be 15-20 hours per month.
Essential Functions
- Responsible for the medical review activities of assigned contracts.
- Conducts critical medical reviews to ensure the care provided is appropriate and medically necessary.
- Assists UM review staff with critical reviews and advises staff on opportunities to improve the healthcare of the populations our contracts serve.
- Serves as a medical expert with peer review and appeals processes.
- Maintains knowledge of industry standards/best practices to inform decision making and policy development.
- Works closely with those teams to meet critical timelines.
- Attends appeal hearings virtually through MS Teams call or telephone.
- Abides by company and accrediting body policies and procedures for medical reviewers. Contribute to medical necessity criteria development as requested.
- Performs miscellaneous duties as assigned, e.g training.
Requirements
- Successful completion of a doctoral program and a current unrestricted clinical license to practice psychology.
- Iowa licensed or eligible to become licensed in the state of Iowa.
- Experience working with individuals with an intellectual disabilities, developmental disabilities, and autism spectrum disorder.
- Experience administering and interpreting psychological assessments.
- Experience working with care management programs (health utilization management, case management and/or disease management) preferred.
Who We Are:
Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.
Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions.
Our business is our people and we’re seeking talented individuals who share our passion and are ready to take ownership, make an impact and helth shape the future of health.
Are you Ready?
We’re on a mission to transform lives and economies by improving health.
Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.
Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.
Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.
Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence.
Thank you for your interest in Telligen!
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While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate.
Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants.
Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.
