[Hiring] Senior Clinical Review Therapist - Physical Health @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.

Remote Role: Monday - Friday, 8AM to 5PM

Senior Clinical Review Therapists - Pediatrics Physical Therapy Specialty

• Performs complex clinical reviews of clinical therapy services and/or durable medical equipment to members based on service request assessments.
• 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.
• Assesses and performs utilization reviews of service requests regarding complex specialty therapy services and/or durable medical equipment for members.
• Manages and collaborates with Utilization and Care Management team and healthcare providers to ensure members are receiving 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.
• Provides feedback to leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members.
• 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