Clinical Reviewer, Physical Therapy- Full Time/40 hours

Evolent Health • Juneau, AK

410d • $72,800 - $83,200

About The Position

The Clinical Reviewer for Physical Therapy at Evolent Health plays a crucial role in evaluating cases that do not pass the initial authorization approval process. This position involves working closely with call center staff and Physician clinical reviewers to ensure that patients receive appropriate care while adhering to established clinical review criteria. The role emphasizes a supportive team approach and requires strong communication skills to interact with medical office staff and provide optimum customer service.

Requirements

• Current, unrestricted state licensure as a Physical Therapist.
• A physical therapy degree from a CAPTE accredited education program and passing the national certification examination.
• 5+ years of clinical experience.
• Strong interpersonal and communication skills.
• Basic computer skills; ability to talk and type simultaneously.

Responsibilities

• Review charts and analyze clinical record documentation to approve services that meet clinical review criteria.
• Monitor established quality of care standards in the participating provider network and for other clinical staff.
• Conduct regular audits to ensure guidelines are applied appropriately.
• Refer cases to the Physician Clinical Reviewer when an approval cannot be rendered, or make denial determinations as warranted.
• Communicate with medical office staff to obtain additional clinical history/information and notify them of approvals and denials with clinical rationale.
• Document all communication with medical office staff and/or treating providers.
• Adhere to policies and procedures of utilization management.
• Participate in ongoing training programs to ensure compliance with applicable standards and regulations.

Benefits

• Comprehensive health insurance benefits
• Bonus component based on performance factors

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Professional, Scientific, and Technical Services
• Education Level: No Education Listed