Clinical Reviewer, Physical Therapy- Part-time, 19 hours

Evolent Health • Lansing, MI

401d • $72,800 - $83,200

About The Position

The Clinical Reviewer for Physical Therapy at Evolent Health is responsible for evaluating cases that do not pass the authorization approval process. This part-time role involves reviewing clinical documentation, conducting audits, and ensuring compliance with quality care standards while providing excellent customer service. The position requires collaboration with medical office staff and adherence to utilization management principles.

Requirements

• Current, unrestricted state licensure as a Physical Therapist.
• Physical therapy degree from a CAPTE accredited 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 cases that do not pass the authorization approval process.
• Review charts and analyze clinical record documentation to approve services that meet clinical review criteria.
• Monitor established quality of care standards in the provider network and for clinical staff.
• Conduct regular audits to ensure guidelines are applied appropriately.
• Refer cases to the Physician Clinical Reviewer when necessary and make denial determinations as warranted.
• Communicate with medical office staff to obtain additional clinical history and notify them of approvals and denials.
• 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 standards and regulations.

Benefits

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

What This Job Offers

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