[Hiring] Clinical Review Therapist @Centene Corporation

Role Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Required Work Schedule: Monday – Friday: 9 am – 6 pm (CST), and a rotational Weekend Day shift, either Saturday or Sunday. Flexibility is required.

• Performs clinical reviews of clinical therapy services and/or durable medical equipment to members based on service request assessments and provides clinical expertise based on practice standards.
• Works with senior management to identify ways to improve the review and execution of therapy services based on clinical reviews of service request assessments.
• Performs utilization reviews of service requests regarding specialty therapy services and/or durable medical equipment for members based on best practice and documentation standards by the national therapy associations and organizational policies.
• Provides recommendations for therapy determinations and refers members to care management, as appropriate, based on service request assessments.
• Works with Utilization and Care Management teams and healthcare providers to ensure members are receiving the appropriate care and treatment.
• Expands therapy specialty knowledge and works with senior management to identify areas of improvement with therapy services and/or durable medical equipment for members.
• Assists with providing education including developing clinical trainings, consultations, and guidance related to therapy authorizations and/or durable medical equipment.
• Provides feedback to leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Requires a Bachelor's degree and minimum of 2 – 4 years of related specialty therapy experience (e.g. OT, PT, and SLP).

Requirements

• Master’s degree in area of specialty therapy and 7+ years of experience providing therapy services in-patient, outpatient, home health, and/or managed care settings preferred.
• Clinical knowledge of clinical therapy services, durable medical equipment, and assisted therapy devices preferred.
• Experience with Adult and Pediatric Therapy experience preferred.
• Advanced clinical knowledge and ability to assess member needs in context of treatment and therapy authorizations.
• Knowledge of therapy regulations and guidelines preferred.
• Knowledge of utilization management processes preferred.
• Role requires adaptability and flexibility to business changes and new work and technology processes.
• Strong communication, strong attention to detail, organizational and time management skills.
• Microsoft Office applications (Co-Pilot, Excel, Outlook, Word, OneNote) and the ability to use multiple avenues of digital communication (e.g. instant messaging, email, phone, video conferencing).
• Comfortable using digital video conferencing platforms (Zoom, MS Teams) is required.

Licenses/Certifications

• OT–Occupational Therapist- Registered required or
• PT - Physical Therapist required or
• CCC-SLP - Speech-Language Therapist required and must have an active Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.