Clinical Reviewer, OT

Cohere Health

4d • $95,000 - $105,000 • Remote

About The Position

We are looking for a licensed Occupational Therapist (OT) who has expertise in occupational therapy to deliver on Cohere’s therapy programs by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. Reporting to a Managing Medical Director, 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

• Master’s degree in Occupational Therapy from an accredited program
• Active, unrestricted Occupational Therapist license in the state of practice
• 5 or more 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

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

• Medical, dental, vision, life, disability insurance, and Employee Assistance Program
• 401K retirement plan with company match
• flexible spending and health savings account
• Flex Time Off + company holidays
• Up to 14 weeks of paid parental leave
• Pet insurance

What This Job Offers

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