Advanced Therapy Services Reviewer

Elevance Health•Indianapolis, IN

5d•Remote

About The Position

The Advanced Therapy Services Reviewer is responsible for conducting timely and quality clinical case evaluations to determine the medical necessity of therapy service requests, ensuring prompt, consistent, and compliant decision-making. This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

Requirements

Requires BA/BS in physical therapy, occupational therapy, or speech language pathology physical therapy and minimum of 1-year clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current valid, active and unrestricted license as a physical therapist, occupational therapist, or speech language pathologist in applicable state(s) required.

Nice To Haves

Master’s degree or higher in physical therapy, occupational therapy, or speech language pathology strongly preferred.

Responsibilities

Conduct clinical case reviews to assess the medical necessity of therapy services (physical therapy, occupational therapy, and/or speech-language pathology).
Support medical management staff to ensure consistent, timely decisions for members and providers.
Lead peer-to-peer calls with therapist providers to gather clinical information and make determinations.
Render adverse determinations for specific clients when appropriate.
Document findings, develop analyses, and submit reports in compliance with regulatory standards.
Apply company medical policies and guidelines consistently when making decisions.
Escalate cases requiring Medical Director review or policy interpretation.
Participate in departmental projects and initiatives.
Maintain established quality and productivity standards.