Reviewer – Therapy Services – Commercial

🔥 0 minutes ago

⛰️ Colorado, Nevada, +1 more states – Remote

⛰️ Colorado – Remote 🎰 Nevada – Remote ⚔️ Virginia – Remote

💵 $29 - $52 / hour

⏰ Full Time

🟢 Junior

😶‍🌫️ Therapist

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Review medical records to determine whether physical therapy, occupational therapy, and/or speech-language pathology requests are medically necessary and filed appropriately • Follow system guidelines and make care approval decisions • Process system-generated authorization decisions while meeting contract requirements, operational goals, and customer satisfaction standards • Document findings, develop analyses, and submit reports in accordance with government regulations and requirements • Research and obtain additional data as needed • Consult with clinical reviewers and medical directors when necessary • Act as a resource for internal and external customers • Participate in intradepartmental teams, projects, and initiatives • Maintain quality and productivity standards • Complete reviews within required timeframes

🎯 Requirements

• 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 • Minimum of 1 year of clinical experience • Alternatively, any combination of education and experience providing an equivalent background • Current, active, unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in the applicable state required • Certification and/or licensure appropriate to the field of specialty required • For URAC-accredited areas, current, active, unrestricted license in occupational, speech, or physical therapy to practice as a health professional within the scope of practice in applicable U.S. state(s) or territory required • Must be located in a U.S. state or territory when conducting a peer clinical review, unless expressly allowed by law or regulation • Strong oral, written, and interpersonal communication skills • Problem-solving skills • Facilitation skills • Analytical skills • Utilization Management and/or Skilled Nursing experience preferred • Prior Authorization and Ongoing Continued Care experience preferred • Commercial Review experience preferred • Must be within reasonable commuting distance of a posting location unless an accommodation is granted • Tuesday–Saturday or Sunday–Thursday schedule, 8:00 AM–5:00 PM local time • Training Monday–Friday, 8:00 AM–4:30 PM CST for at least 3 weeks • New candidates in certain patient/member-facing roles must meet the stated COVID-19 and Influenza vaccination requirement, subject to acceptable explanation and applicable law

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401(k) contribution and match • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Required COVID-19 and Influenza vaccination for certain patient/member-facing roles, subject to stated exceptions