Reviewer - Therapy Services

Reviewer - Therapy Services

Location: Virtual: This role enables associate to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

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

The Reviewer - Therapy Services is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) were medically necessary and filed appropriately.

How you will make an impact:

• Follows the system guidelines that makes 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.
• May participate in intradepartmental teams, projects, and initiatives.
• Maintains quality and productivity standards and ensures reviews are conducted within required timeframes.

Minimum Requirements:

• Requires 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; or any combination of education and experience, which would provide an equivalent background.
• 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.

Preferred Skills, Capabilities, and Experiences:

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

Job Level: Non-Management Non-Exempt