Therapist Reviewer

Therapist Reviewer

NCMMIS is in search of 1 Therapist Reviewer.

Labor Category Therapist Reviewer

Temp position (conversion to CSRA possible)

Selection based upon candidate's ability to meet Basic Qualifications at the best value.

Rate will need to be established on agreement prior to starting of approved candidate. If rate is not already established please inquire with SCA on NTE Program rate prior to submitting candidates/proposed rate.

Job Description

Analyzes durable medical equipment (DME) prior approval requests for NC Medicaid to ensure compliance with clinical guidelines

Performs review of documentation submitted prior approval requests for DME services to determine if the recipient is eligible for the services being requested

Contract Labor Category Description / Requirements

Therapist Reviewer - Performs reviews of prior approval requests submitted by enrolled providers. Escalates problems to appropriate personnel, as appropriate. - Bachelor's degree or equivalent combination of education and experience - Two years allied health experience

Required Skillset

• Requires active NC license as Physical Therapist (in good standing)
• Ability to work independently to meet individual performance standards
• Must be comfortable with using a computer
• Knowledge of Microsoft Office and Outlook
• Prefer to have knowledge of NC Tracks
• Prefer to have knowledge of business processes of NC DHHS and/or NC Health Choice
• Prefer experience with DME and pediatric physical therapy
• 2 years physical therapy experience
• Active NC License as Physical Therapist (in good standing)

Work Environment

• Office environment

Additional Information

• Place of Performance - 2610 Wycliff Rd, Raleigh, NC
• Period of Performance Start date and ongoing (conversion to CSRA possible)