[Hiring] Senior Clinical Review Therapist @Centene Corporation

Role Description

Performs complex 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. Applies clinical knowledge and provides recommendations to senior management team to identify ways to improve the review and execution of therapy services based on clinical reviews of service request.

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
• Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
• Applicants for this role have the flexibility to work remotely within the continental United States.
• Schedule: The work schedule includes holiday coverage.
• Assesses and performs utilization reviews of service requests regarding complex 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.
• Manages and collaborates with Utilization and Care Management team and healthcare providers to ensure members are receiving the appropriate care and treatment.
• Applies advanced clinical therapy specialty knowledge and identifies areas of concern and improvement with therapy services and/or durable medical equipment for members.
• Provides education including developing clinical trainings, consultations, and guidance related to therapy authorizations and provisions.
• Partners with leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies.
• 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 4 – 6 years of related experience.
• Advanced clinical knowledge of clinical therapy services and/or durable medical equipment preferred.
• Strong knowledge of therapy regulations and guidelines preferred.
• Strong knowledge of utilization management processes preferred.

Requirements

• PT - Physical Therapist required or
• OT - Occupational Therapist – Registered required or
• ST - Speech Therapist required

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