Physical Therapist
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Job Description
Physical Therapist conducting medical necessity and utilization reviews for Trillium Health Resources, a North Carolina behavioral health managed care organization. Coordinating clinical determinations, triage, and care planning.
Responsibilities:
- Facilitate, coordinate, and approve medically necessary reviews in accordance with established criteria
- Evaluate clinical information and apply medical necessity criteria
- Provide consultation to ensure appropriate utilization and timely, accurate determinations, notifications, and reconsiderations
- Perform medical reviews to determine medical necessity and appropriate level of care
- Interpret clinical documentation, diagnoses, and treatment plans to support determinations
- Conduct clinical assessments and provide recommendations to support care planning and member needs
- Perform clinical triage
- Collaborate with internal and external care teams to develop and implement care plans
- Document clinical reviews, rationale, and determinations within required timeframes and systems
Requirements:
- Master’s degree in Physical Therapy
- One (1) year of utilization management or utilization review experience, including acute inpatient care, outpatient care, rehabilitation, behavioral health, compliance, or use of evidence-based clinical decision support tools (e.g., MCG, InterQual)
- Fully licensed by the North Carolina Board of Physical Therapy Examiners as a Physical Therapist
- Must have a valid driver’s license
- Must reside within North Carolina
- Must be able to travel within catchment as required
- Clinical experience in a managed care organization, health plan or hospital setting (preferred)
- Utilization Management certification or equivalent certification (preferred)
- Resume must include employer name, dates of service, average hours worked per week, and essential job duties
- Resume must include education details: degree type, date awarded, institution, and field of study
- Resume must include licensure/certification information, if applicable
- All candidates must pass a drug test as a condition of employment
Benefits:
- Competitive benefits
- Work-from-home options for most positions
- Flexible work schedules available for some positions with management approval
- Health Insurance with no premium for employee coverage
- Flexible Spending Accounts
- 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year
- NC Local Government Retirement Pension (defined-benefit plan)
- 401k with 5% employer match and immediate vesting
- Public Service Loan Forgiveness (PSLF) qualifying employer
- Quarterly stipend for remote work supplies
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