Physical Therapist, PT
Urrly
Senior Clinical Review Therapist – Physical Health
Centene Corporation
full-time
Posted on:
Origin: • 🇺🇸 United States • North Carolina
Visit company websiteSalary
💰 $35 - $64 per hour
Job Level
Senior
About the role
- Performs complex clinical reviews of clinical therapy services and/or durable medical equipment to members based on service request assessments
- Applies clinical knowledge and provides recommendations to senior management to improve review and execution of therapy services
- Assesses and performs utilization reviews of complex specialty therapy services and/or durable medical equipment based on best practice and documentation standards
- Manages and collaborates with Utilization and Care Management teams and healthcare providers to ensure appropriate care
- Applies advanced clinical therapy specialty knowledge and identifies areas of concern and improvement
- Provides education by developing clinical trainings, consultations, and guidance related to therapy authorizations and provisions
- Partners with leadership to improve review processes and therapy outcomes
- Provides feedback to leadership and performs other duties as assigned
- Complies with all policies and standards
Requirements
- Requires a Bachelor's degree
- 4 – 6 years of related experience (minimum 4 years)
- Advanced clinical knowledge of clinical therapy services and/or durable medical equipment preferred
- Strong knowledge of therapy regulations and guidelines preferred
- Strong knowledge of utilization management processes preferred
- License/Certification: PT - Physical Therapist required OR OT - Occupational Therapist – Registered required OR ST - Speech Therapist required
- PT role: Pediatric and Adult experience required
- OT role: Pediatrics required
- ST role: Pediatrics required
- Candidates located in EST or CST preferred
