Physical Therapist, Occupational Therapist – Therapy Services Reviewer
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Job Description
Therapy Services Reviewer responsible for reviewing medical records to assess therapy service requests. Part of Elevance Health, focusing on healthcare improvements.
Responsibilities:
- 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.
Requirements:
- Requires 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 and 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.
Benefits:
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical, dental, vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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