About the AHS Peer Review Program
About Alliant Health Solutions
Alliant Health Solutions is a nonprofit, physician-led organization dedicated to improving the quality, safety, and integrity of
value-driven healthcare. We provide medical peer review services, utilization and quality of care review, and healthcare outcomes research for a variety of programs. For more than four decades, we have provided innovative leadership on healthcare quality improvement projects for federal, state, and private sector clients. Our medical review services have been accredited by URAC since 1997.
At Alliant Health Solutions, we believe that a peer review organization is the best approach for fair and honest reviews and improved value. We also believe in building positive provider relationships based on our commitment to full and open communication, education and reliance on nationally accepted guidelines in evidenced-based medicine.
To accomplish this, Alliant is committed to providing a qualified staff of professionals for peer review. We engage peer reviewers based upon medical expertise in a specific field of practice, prior utilization/peer review experience, and professional standing within the community. Each consultant reviews only in his or her area of specialization. In addition, we attempt to match practice setting, i.e. rural clinicians reviewing rural cases. There are many reasons to become a Clinical Peer Reviewer:
- To improve patient outcomes
- To ensure the value of our healthcare dollars
- To promote fairness, accuracy, and consistency
- To foster continuous improvement in health care
- For the good of your own patients and community
Clinical Peer Reviewer Network
Our range and depth are large and growing. We have more than 200+ physician and non-physician consultants in our Clinical Peer Reviewer database who are certified in a combined total of more than 60 supportive medical disciplines.
Being a Clinical Peer Reviewer with Alliant Health Solutions is a way of promoting better health care for your community. It’s a way of demonstrating your belief in quality performance improvement, and in helping to create a medical staff culture of accountability and excellence.
We know, too, that if a utilization review system is to have an impact, we must focus on determining the medical necessity and appropriateness of setting, and to monitor the quality of services rendered. To accomplish this, Alliant is committed to providing a qualified staff of professionals for peer review. Clinical Peer Reviewers play a role of promoting better health care and quality improvement in the community. Each consultant reviews only in his or her area of specialization. In addition, we attempt to match practice setting, i.e. rural clinicians reviewing rural cases.
Summary of Peer Reviewer Responsibilities:
- Complete peer reviews within contract specified time frames and in accordance with state/federal policies and regulations
- Make written case review determinations regarding the medical necessity and appropriateness, experimental or investigational treatment, administrative or legal issues in case reviews
- Clinical Peer Reviewers must be free from any and all Conflicts of Interest and must attest to such for each case reviewed
- As needed, serve on a specialty panel to provide medical expertise on various special projects
- As needed, represent Alliant Health Solutions as an expert witness in legal proceedings in their area of clinical specialty
Some important facts to consider:
- The primary objective of the Clinician Peer Reviewer is to make a determination regarding the medical necessity and appropriateness of care.
- The Clinician Peer Reviewer may be asked to serve on a specialty panel to provide medical expertise on various special projects.
- The Clinician Peer Reviewer may be asked to represent Alliant Health Solutions as an expert witness in legal proceedings in their area of clinical specialty.
Peer Reviewer Qualifications
Alliant Health Solutions selects peer reviewers based upon medical expertise in a specific field of practice, prior utilization/peer review experience and professional standing within the community. Consideration is given to ensure peer reviewers, in so far as possible, are racially and geographically balanced and currently enrolled in the Medicaid Program. Physician reviewers should be certified by the American Board of Medical Specialties. The credentialing process consists of each reviewer furnishing Alliant Health Solutions with credentials, which are verified as a prerequisite of being retained as a consultant. The credentialing process consists of reviewing documentation of:
- Current, non-restricted license to practice medicine
- Hospital and/or other medical practice privilege
- Certification by the American Board of Medical Specialties, for physicians
We hope you’ll consider joining us.
To download the Clinical Peer Reviewer application, CLICK HERE.
For information or to submit an inquiry please email: firstname.lastname@example.org.