1099 Physician Reviewer- Psychologist

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. Health has changed a lot through our 50-year history, but what has remained constant is that we care deeply about who we serve and what we do. Our success is built on our ability to adapt, respond to client needs, and offer innovative solutions. Our business is our people and we’re looking for talented individuals who not only believe in our mission but who are ready to take ownership and make a difference in the lives of people, in the world of health. Learn more about who we are and what we do at www.telligen.com/about-us Are you Ready? We’re on a mission to transform lives and economies by improving health and getting there means following through on our values of Ownership, Community, Ingenuity & Integrity.  Ownership: As a 100% employee-owned company, our employee-owners drive our business, our solutions, and share in our success. When employee-owners grow and thrive, we all win.Community: Putting others first and being a good corporate partner wherever we work, and play makes us who we are. We Show Up. For our clients, for our communities, and for each other.Ingenuity: We’re a team of passionate professionals driven by hard work and big ideas. We understand that high-value breakthroughs come from taking calculated risks. If it will benefit our clients and advance our mission, we’re all ears. We celebrate free-thinking and challenge the status quo, so brainstorm away! Integrity: Smiling faces (virtual or in-person) are the norm around here. We enjoy a friendly work environment where everyone is dedicated to mutual trust, respect, and excellence.  Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed.
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.As part of our commitment to health and safety, some roles may require additional health protocols (i.e. personal protective equipment or vaccination).Telligen and our affiliates are Affirmative Action, 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. Telligen does not accept 3rd party solicitations from outside staffing firms.