Clinical Reviewer, Speech Therapy
Evolent
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- Functions in a clinical review capacity to evaluate all cases that do not pass the authorization approval process at first call
- Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria
- Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff
- Conducts regular audits, as assigned, to ensure guidelines are applied appropriately
- Converses with medical office staff to obtain additional pertinent clinical history/information, notifies of approvals and denials, giving clinical rationale
- Provides optimum customer service through professional/accurate communication while maintaining NCQA and health plans required timeframes
- Documents all communication with medical office staff and/or treating provider
- Practices and maintains the principles of utilization management by adhering to policies and procedures
- Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations
Requirements
- Current, unrestricted state licensure as a Speech Therapist
- A Speech Therapist must hold a state license in Speech Therapy and hold a Speech therapy degree from an accredited education program and pass the national certification examination
- 5+ years clinical is Preferred
- Strong interpersonal and communication skills
- Strong clinical, communication, and organizational skills
- Energetic and curious with a passion for quality and value in health care
- Computer Proficiency
- Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid
- No history of disciplinary or legal action by a state medical board
Benefits
- Health insurance benefits
- Flexible work/life balance
- Autonomy to suit work to life
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical reviewchart reviewclinical documentation analysisquality of care standardsauditingutilization managementSpeech Therapy degreenational certification examinationclinical experience
Soft skills
interpersonal skillscommunication skillsorganizational skillscustomer serviceprofessional communicationenergeticcuriositypassion for qualityvalue in health care
Certifications
state licensure as a Speech Therapist