Physical Therapist Case Manager - Remote
About The Position
Optum Physical Health is seeking a Physical Therapist Case Manager to review clinical submissions and prior authorizations, improve clinical outcomes, and promote evidence-based use of therapy services. The role also involves responding to providers’ questions about the clinical submission process and clinical review outcomes. The position supports multiple health plan structures, including Fully Insured, Medicare, and Medicaid, and works to improve care quality and outcomes while managing utilization. This is a remote role available anywhere in the U.S. Employees working remotely must adhere to UnitedHealth Group’s Telecommuter Policy. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. in the employee’s time zone.
Requirements
- Active, unrestricted license to practice Physical Therapy in the state of residence.
- At least 5 years of experience as a Physical Therapist in an adult outpatient orthopedic environment.
- Experience interpreting guidelines and research in the context of traditional Physical Therapy practice.
- Ability to consult with supervisory, clinical, and non-clinical professionals.
- Proficient knowledge of practice guidelines, including office procedures, current research, and scope of practice.
- Proficiency with Microsoft Office tools, including Outlook, Word, Excel, and MS Teams.
- A dedicated, distraction-free home workplace with high-speed internet access through broadband cable, fiber, or DSL.
Nice To Haves
- At least 5 years of clinical experience performing case review.
- Experience in a managed care environment, such as a health plan or medical group.
Responsibilities
- Determine the medical necessity and clinical appropriateness of treatment.
- Assist with implementing clinical policies, guidelines, and applications.
- Contact providers when treatment determination patterns vary from those of their peers and community.
- Understand and apply regulatory requirements for assigned regions.
- Manage prospective, concurrent, and retrospective utilization and implement healthcare affordability initiatives across UnitedHealthcare regions.
- Take initiative to control utilization trends while maintaining focus on quality and consumer outcomes.
- Implement strategies to improve the quality and outcomes of care for consumers.
- Support Fully Insured, Medicare, and Medicaid health plan structures.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase program.
- 401(k) contribution, subject to eligibility requirements.
- Career development opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
