Clinical Reviewer, Physical Therapy- Full Time/40 hours

Evolent Health • Bismarck, ND

394d • $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 emphasizes a supportive team approach, working closely with call center staff and physician clinical reviewers to ensure quality care and compliance with established standards. The role requires a commitment to customer service and adherence to utilization management principles while maintaining a flexible work schedule.

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

• Evaluate all cases that do not pass the authorization approval process at first call.
• 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 quality performance in compliance with applicable standards and regulations.

Benefits

• Comprehensive health insurance benefits
• Bonus component based on predefined 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