Clinical Review Therapist - Physical Health

Centene Corporation

1d • $31 - $55

About The Position

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Flexible Work Schedule: Monday – Friday between the hours: 6 am - 5 pm (CST) NOTE: OT, PT, CCC-SLP licensure must be issued by the state of Texas. Position Purpose: 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

Requirements

• Requires a Bachelor's degree and minimum of 2 – 4 years of related specialty therapy experience (e.g. OT, PT, and SLP).
• OT–Occupational Therapist- Registered required or PT - Physical Therapist required or CCC-SLP - Speech-Language Therapist required and must have an active Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association.
• Role requires adaptability and flexibility to business changes, distribution of work, training, and technology processes
• 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

Nice To Haves

• 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.

Responsibilities

• 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

Benefits

• Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level