Reviewer – Therapy Services

Elevance Health

Therapy services reviewer assessing medical necessity for Elevance Health, a whole-health company. Reviewing authorizations, documenting findings, and coordinating with clinical reviewers and medical directors.

Posted 8/10/2026full-timeMason • Florida, Kentucky, Ohio, Wisconsin • 🇺🇸 United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in reviewing medical records for therapy requests, ensuring compliance with government regulations, and maintaining quality standards. Holds a valid license or certification in physical therapy, occupational therapy, or speech-language pathology, with strong communication and analytical skills.

Highest-signal resume keywords

Clinical ExperienceUtilization ManagementPrior AuthorizationLicensure in Physical TherapyAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Record ReviewCare Approval DecisionsDocumentation and ReportingData ResearchQuality Standards Maintenance

Soft Skills

Oral CommunicationWritten CommunicationInterpersonal SkillsProblem-SolvingFacilitation Skills

Certifications & Qualifications

Physical Therapist Assistant LicenseOccupational Therapist Assistant LicenseSpeech Language Pathologist Assistant License

Industry Keywords

Utilization ManagementSkilled NursingMedicare Advantage ReviewGovernment RegulationsPeer Clinical Review

About the role

Key responsibilities & impact

Review medical records to determine whether physical therapy, occupational therapy, and/or speech-language pathology requests are medically necessary and filed appropriately
Follow system guidelines to make care approval decisions
Process system-generated authorization decisions while meeting contract requirements, processes, and operational goals
Document findings, develop analyses, and submit reports to appropriate departments in accordance with government regulations
Research and obtain additional data
Consult with clinical reviewers and medical directors when necessary
Act as a resource for internal and external customers
Participate in intradepartmental teams, projects, and initiatives
Maintain quality and productivity standards
Complete reviews within required timeframes

Requirements

What you’ll need

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
Minimum of 1 year of clinical experience, or an equivalent combination of education and experience
Current, active, unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in the applicable state required
Certification and/or licensure appropriate to the field of specialty required
For URAC-accredited areas: current, active, unrestricted license in occupational, speech, or physical therapy to practice as a health professional within the scope of practice in applicable U.S. state(s) or territory
Must be located in a state or territory of the United States when conducting a peer clinical review, unless expressly allowed by law or regulation
Strong oral, written, and interpersonal communication skills
Problem-solving, facilitation, and analytical skills
Utilization Management and/or Skilled Nursing experience preferred
Prior Authorization and Ongoing Continued Care experience preferred
Medicare Advantage Review experience preferred

Benefits

Comp & perks

Virtual full-time work arrangement with flexibility and autonomy
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short- and long-term disability benefits
401(k) with company match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources