Peer Review Psychiatrist

About the role

As a Peer Review Psychiatrist, you will conduct peer reviews and appeals to ensure the level of care is appropriate and necessary for Concurrent Acute Inpatient Psychiatric requests.

Responsibilities

• Evaluate Care Quality: Perform peer reviews to ensure healthcare services meet necessity and appropriateness standards
• Manage Contract Reviews: Direct medical review activities across assigned contracts
• Serve as the subject matter expert on peer review processes
• Articulate Telligen’s policies to diverse medical and non-medical audiences

Requirements

• Active, unrestricted medical license in California (or willingness to obtain) and the contracted state
• Board certification in Psychiatry or Neurology by a US board (active and unrestricted)
• Proven background in utilization management and several years of hands-on clinical practice
• Working knowledge of MCG or InterQual medical necessity criteria

Qualifications

Preferred Skills and Experience

• Mastery of DSM-5 and ICD-10 criteria to accurately evaluate complex mental health conditions
• Deep understanding of psychiatric medications, side effects, and evidence-based treatment algorithms
• Comfort with electronic health records (EHRs) and utilization review software
• Familiarity with state and federal guidelines, HIPAA compliance, and insurance or Medicaid-specific medical necessity criteria
• Skill in conducting conversations clearly, professionally, and respectfully with treating clinicians
• Capacity to write clear, concise, and evidence-based rationales for decisions or quality evaluations

About Us

Telligen is one of the most respected population health management organizations in the country. We offer clinical, analytical, and technical expertise to support local, Tribal, and national partners, state and federal government programs, and employers and health plans. 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 help shape the future of health.

Values

• 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.