Clinical Review Therapist – Physical Health

📋 Description

• Conducts clinical evaluations of therapy services and/or durable medical equipment based on assessments of service requests.

• Offers clinical expertise in accordance with established practice standards.

• Identifies opportunities for enhancing the review process and implementation of therapy services.

• Executes utilization assessments of service requests related to specialized therapy services and durable medical equipment.

• Makes recommendations for therapy determinations and connects members with care management services.

• Collaborates with Utilization and Care Management teams to ensure proper care and treatment.

• Enhances knowledge in therapy specialties and pinpoints areas needing improvement.

• Supports clinical training, consultations, and guidance pertaining to therapy authorizations.

• Provides leadership with feedback on potential improvements for outcomes.

⛳️ Requirements

• A Bachelor's degree and at least 2 to 4 years of relevant experience in specialty therapy (e.g., OT, PT, and SLP) is required.

• A Master's degree in a specialty therapy area along with 5 or more years of experience is preferred.

• Preferred clinical knowledge of therapy services, durable medical equipment, and assistive therapy devices.

• Experience in both Adult and Pediatric Therapy is preferred.

• Advanced clinical understanding and the ability to evaluate member needs concerning treatment and therapy authorizations.

• Familiarity with therapy regulations and guidelines is preferred.

• Knowledge of utilization management processes is preferred.

• Excellent communication, attention to detail, organizational, and time management skills are essential.

• Proficiency in Microsoft Office applications (Co-Pilot, Excel, Outlook, Word, OneNote) is required.

• Comfort with digital video conferencing platforms (Zoom, MS Teams) is necessary.

🏝️ Benefits

• Competitive pay

• Health insurance

• 401K and stock purchase plans

• Tuition reimbursement

• Paid time off plus holidays

• Flexible work arrangements including remote, hybrid, field, or office work schedules