Clinical Reviewer, DPT

Cohere Health

17d • $95,000 - $105,000 • Remote

About The Position

We are looking for Doctors of Physical Therapy (DPT) who have expertise in Physical Therapy to deliver on Cohere’s musculoskeletal and orthopedic programs by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines.
Reporting to the Medical Director MSK Spine and Ortho for Cohere Health, and part of the review team that includes non-clinical intake specialists and nurses. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives.

Requirements

• Doctor of Physical Therapy (DPT) from a CAPTE-accredited physical therapy program
• Active, unrestricted Physical Therapist license in the state of practice (or eligibility for licensure)
• 5+ years of direct clinical patient care experience
• Familiarity with facilities rendering care in PT, OT, SLP
• 1+ years of managed care utilization review experience, preferably in an utilization management organization within a Medicare, Commercial or Medicaid payor organization preferred

Nice To Haves

• Membership in national and/or regional specialty societies preferred

Responsibilities

• Provide timely medical reviews that meet Cohere’s stringent quality parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen
• Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision
• Use correct templates for documenting decisions during case review
• Meet the appropriate turn-around times for clinical reviews
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
• Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
• Support projects specific to building the team's clinical expertise and efficiency, as delegated
• Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated

Benefits

• Fully remote opportunity with about 5% travel
• Medical, dental, vision, life, disability insurance, and Employee Assistance Program
• 401K retirement plan with company match; flexible spending and health savings account
• Up to 184 hours (23 days) of PTO per year + company holidays
• Up to 14 weeks of paid parental leave
• Pet insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree