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Transforming the health of the communities we serve, one person at a time.
OT, PT, Speech Therapy – Utilization Review
Location
Arizona + 3 moreAll locations: Arizona | Kansas | Nebraska | Texas
Posted
56 days ago
Salary
$30 - $55 / hour
Seniority
Mid Level
Job Description
OT, PT, Speech Therapy – Utilization Review
Centene Corporation
• Performs clinical reviews of clinical therapy services and/or durable medical equipment to members based on service request assessments and 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.
Job Requirements
- Requires a Bachelor's degree and minimum of 2 – 4 years of related specialty therapy experience (e.g. OT, PT, and SLP).
- Preferred Education/Experience: 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 experience 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, 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).
- Comfortable using digital video conferencing platforms (Zoom, MS Teams) is 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
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