Utilization Review, Health Plan - Occupational Therapist

Cook Children's Health Care System • Calmont Operations Building, TX

8d • Onsite

About The Position

Responsible for the coordination and efficient utilization of therapy health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager to assure the provision of quality care throughout the continuum of care. The Occupational Therapist Utilization Management (OT -UM) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers, health plan medical directors, and all other members of the health care and health plan team. The OT-UM Reviewer assesses and identifies the patients clinical findings and determines, in conjunction with the Medical Director utilizes protocols, pathways, and evidence based clinical tools, to assess the level of therapy care appropriate for the member. The OT UM Reviewer communicates with providers of care/services to facilitate appropriate levels of therapy care. The OT UM Reviewer participates with the Department Manager reviewing and updating evidence-based standards of occupational and other therapy care and services for CCHP.

Requirements

• Bachelors or Master's degree in Occupational Therapy.
• Current, unrestricted licensure for Occupational Therapist in the state of Texas.
• Strong skills in oral and written communication.
• Strong skills in critical thinking.
• Strong skills in organization and time management.
• Strong skills in customer service.

Nice To Haves

• Health plan utilization management experience preferred.

Responsibilities

• Coordinate and efficiently utilize therapy health care resources for Cook Childrens Health Plan (CCHP) members.
• Assure the provision of quality care throughout the continuum of care in conjunction with the Department Manager.
• Facilitate clinically appropriate and fiscally responsible care through communication with providers, health plan medical directors, and the health care and health plan team.
• Assess and identify patients' clinical findings.
• Determine the appropriate level of therapy care for members in conjunction with the Medical Director, utilizing protocols, pathways, and evidence-based clinical tools.
• Communicate with providers of care/services to facilitate appropriate levels of therapy care.
• Participate with the Department Manager in reviewing and updating evidence-based standards of occupational and other therapy care and services for CCHP.

What This Job Offers

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