Reviewer - Therapy Services

About the role

The Reviewer - Therapy Services role enables associates to work virtually full-time, with the exception of required in-person training sessions, promoting productivity, work-life integration, and essential face-to-face onboarding and skill development.

Responsibilities

• Follows the system guidelines to make decisions on approval for care for a patient.
• Processes system generated decisions for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction.
• Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements.
• Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary.
• Acts as a resource for internal and external customers.
• Maintains quality and productivity standards and ensures reviews are conducted within required timeframes.

Requirements

• Graduate of a college level program in physical therapy, occupational therapy, or speech language pathology or an accredited two-year program for a Physical Therapist Assistant, Occupational Therapist Assistant, or Speech Language Pathologist Assistant and minimum of 1 year of clinical experience.
• Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state required.
• Certification and/or licensure appropriate to field of specialty is required.

Qualifications

• Utilization Management and/or Skilled Nursing experience preferred.
• Prior Authorization and Ongoing Continued Care experience preferred.
• Medicare Advantage Review experience preferred.

Skills

• Strong oral, written and interpersonal communication skills.
• Problem-solving skills.
• Facilitation skills.
• Analytical skills.

Benefits

Includes a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Pay

Details of pay are not specified in the job posting.

Schedule

Tuesday - Saturday or Sunday - Thursday 8:00 AM - 5:00 PM.