Clinical Review Therapist – Physical Health
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Job Description
Clinical Review Therapist performing clinical reviews of therapy services for Centene. Collaborating with management to enhance therapy service execution and compliance under organizational standards.
Responsibilities:
- Performs 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
- 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
Requirements:
- Bachelor's degree and minimum of 2 – 4 years of related specialty therapy experience (e.g. OT, PT, and SLP)
- Master’s degree in area of specialty therapy and 5+ 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 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
- Strong communication skills
- 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)
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
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