Medical Reviewer – Physical Therapist

This is a fully remote position, open to applicants in California.

📋 Description

• Review medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documents related to physical therapy.

• Assess the requested therapy services based on clinical documentation, medical policies, and relevant coverage criteria.

• Utilize professional physical therapy principles and clinical judgment to support determinations of medical necessity and appropriateness.

• Accurately and promptly document review findings and the clinical rationale behind them.

• Refer cases that require further clinical review to the appropriate medical professionals as necessary.

• Collaborate with physicians, nurses, therapists, operations teams, and other healthcare professionals to address review inquiries.

• Stay informed about relevant physical therapy standards, medical policies, coverage requirements, and regulatory guidelines.

• Achieve established expectations for quality, accuracy, productivity, and turnaround times.

• Primarily work from a home office while providing support for Medical Review Services for California healthcare programs.

• Navigate various computer systems and applications to complete reviews, document findings, and facilitate timely decisions.

⛳️ Requirements

• A minimum of three (3) years of experience as a Physical Therapist.

• Graduation from an accredited Physical Therapy program.

• A California license to practice Physical Therapy, or eligibility for licensure in California.

• Current professional certification in good standing.

• Strong clinical judgment with the ability to interpret medical records, treatment plans, and therapy-related documentation.

• Excellent written and verbal communication skills.

• Capability to work independently while effectively collaborating with clinical, operational, and cross-functional teams.

• Maintain all professional licenses, certifications, and credentials in active and good-standing status as required for the position.

• Work schedule from Monday through Friday.

• Travel requirement: 0-10%.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Continuous learning and career development opportunities.

• Flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Ongoing training and support.

• Remote work environment.