[Hiring] Physical Therapist/Occupational Therapist (Therapy Services Reviewer) @Elevance Health

Role Description

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

• 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.

Qualifications

• 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.
• 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.

Requirements

• Physical Therapist or Occupational Therapist.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).