Reviewer - Therapy Services

Job summary
The Reviewer - Therapy Services is responsible for reviewing medical records to determine the medical necessity and appropriate filing of requests for therapy services.The role requires a graduate of a college-level program in physical therapy, occupational therapy, or speech-language pathology, or an accredited two-year program for a therapy assistant.A current active unrestricted license or certification in the applicable state is required.
Job seniority: associate level
Responsibilities
• Follow system guidelines to make decisions on approval for care for patients.• Process system-generated decisions for authorization requests, meeting contract requirements and operational goals.• Document findings, develop analyses, and submit reports to appropriate departments.• 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 and conduct reviews within required timeframes.
Requirements
• Graduate of a college-level program in physical therapy, occupational therapy, or speech-language pathology, or accredited two-year program for a therapy assistant.• Minimum 1 year of clinical experience or equivalent combination of education and experience.• Current active unrestricted license or certification as a therapy assistant in applicable state.• Certification and/or licensure appropriate to field of specialty.• 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 state(s) or territory of the United States.• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Benefits
• Comprehensive benefits package• Incentive and recognition programs• Equity stock purchase• 401k contribution