Clinical Review Support Specialist (Remote)

American Specialty Health Incorporated

7d•$48,000 - $60,000•Remote

About The Position

American Specialty Health Incorporated is seeking a Clinical Review Support Specialist to join our Contracts department. This position will support medical necessity review determinations of services requested by Physical Therapy practitioners through provider communication, education, and clinical coordination. Salary Range American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate’s qualifications, education, skill set, years of experience, and internal equity. $48,000 to $60,000 Full-Time Annual Salary Range. Remote Worker Considerations: Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

Requirements

Professional degree as Physical Therapy Assistant from accredited college or university required. Additional post-graduate degree in same or related field a plus.
A current, unrestricted license to practice in their health care specialty. Employees must maintain a current, unrestricted license to practice and must be in good standing with all judicial and governing bodies (Required).
Minimum of 5 years of clinical experience. Specific experience with care coordination or leadership preferred.
Understanding of therapy evidence-based guidelines and best practices required.
Ability to communicate evidence-based criteria and approved guidelines. Ability to independently resolve problems or issues related to ASH processes using good judgment or to escalate problems or issues to supervisor(s) as appropriate.
Use of computer systems in business application including, but not limited to: Outlook, MS Word, IHIS, ASHCore.
Ability and willingness to serve as a resource for practitioners to educate them how to operate within ASH programs and systems most effectively and efficiently.
Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
Ability to effectively organize, prioritize, multi-task, and manage time.
Demonstrated accuracy and productivity in a changing environment with constant interruptions.
Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
Ability to exercise strict confidentiality in all matters.
Primarily sedentary, able to sit for long periods of time, able to travel by automobile and air.??
Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

Nice To Haves

Additional post-graduate degree in same or related field a plus.
Specific experience with care coordination or leadership preferred.
Working knowledge of managed therapy services is a plus.
Advanced training or certification in any specialty areas of Physical Therapy, health care or quality management, case management, performance improvement, data analysis, and quality initiatives also preferred.

Responsibilities

Support of medical necessity review determinations.
Perform outreach calls to practitioners and clinical practices for network and non-network therapy practitioners.
Determine and obtain appropriate clinical assessment for submitted diagnosis codes.
Clarify provider requests, providing education on ASH’s submission process, forms, and available resources.
Facilitate clinical review through coordination and distribution of reviews among Clinical Quality Evaluators.
Collaborate with senior management and various departments regarding clinical program, policies, and protocol development and implementation.
Participate in Clinical Quality Administration and Clinical Quality Evaluation workgroups.
Promote a productive Team environment.
Participate in clinical article review activities as assigned.
Provide interdepartmental Support to Medical Necessity Administration department as necessary for performance of assigned tasks.
Work independently, receiving minimal guidance and supervision.