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. Applicants must possess a NY PT or OT License 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 2 – 4 years of related experience.
Clinical knowledge of clinical therapy services and/or durable medical equipment preferred.
Knowledge of therapy regulations and guidelines preferred.
Knowledge of utilization management processes preferred.
PT - Physical Therapist required or OT - Occupational Therapist – Registered required or ST - Speech Therapist required

Nice To Haves

Clinical knowledge of clinical therapy services and/or durable medical equipment
Knowledge of therapy regulations and guidelines
Knowledge of utilization management processes

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