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Bureau of Program Integrity- Consulting Psychiatrist Position (Physici

Company: MHM Services, Inc.
Location: Harrisburg
Posted on: May 18, 2019

Job Description:

The Bureau of Program Integrity (BPI) ensures Medical Assistance (MA) recipients receive quality medical services and that MA recipients do not abuse their use of medical services; applies administrative sanctions; refers cases of potential fraud to the appropriate enforcement agency and evaluates medical services rendered by medical providers and managed care organization provider networks. The Bureau monitors MA recipient overuse and abuse of medical services; maintains ongoing working relationships with federal and state enforcement agencies involved in monitoring potential health care fraud and abuse and ensures feedback is provided to the Department of Human Services (DHS) to enhance program performance. The Bureau manages the federally mandated cost containment program designed to identify the use of, and recovery from, third-party benefits available to MA recipients, and administers the Estate Recovery Program and the Health Insurance Premium Payment (HIPP) Program. The Department of Human Services, Office of Administration in the Bureau of Program Integrity (BPI) is looking for a Consultant who is Board Certified in Adult Psychiatry and preferably Board Certified in Child and Adolescent Psychiatry. The Consultant will: -Be available as a part-time reviewer at approximately 27 hours per week; flexible work schedule with Work From Home opportunity! -Provide the BPI with consultation for retrospective medical record reviews that include acaute inpatient, outpatient hospital and residential services for children and adolescences to determine the medical necessity, appropriateness of the plan of care, and the quality of care provided to the Medical Assistance recipients. -Be responsible for reviewing all medical records thoroughly -Make qualified determinations in accordance with the Office of Medical Assistance regulations and critera -Compile case finding summaries and make recommendations for case disposition -Testify for the Department at administrative hearings or court proceedings for cases under appeal (telephonic or face-to-face hearings) -Report to the BPI section supervisor and complete a weekly time sheet COMPANY OVERVIEW: In the state of Pennsylvania, MHM Services, Inc. proudly serves as the statewide mental health provider to the Pennsylvania Department of Corrections, Philadelphia Prison System (6 county jails), and, the staffing provider to the Commonwealth of Pennsylvania including all Pennsylvania state hospitals and other various branches of the Commonwealth. For immediate consideration, please contact Tory Anderson at [Click Here to Apply] or [Click Here to Apply] /> Keyphrases: psychiatry jobs, psychiatrist jobs, psychologist jobs, child psychiatry jobs

Keywords: MHM Services, Inc., Harrisburg , Bureau of Program Integrity- Consulting Psychiatrist Position (Physici, Healthcare , Harrisburg, Pennsylvania

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