Physical Therapist - UM

TRILLIUM HEALTH RESOURCES•Remote in North Carolina, NC, US, NC

5h•$80,000 - $113,000•Remote

About The Position

Trillium Health Resources is seeking a Physical Therapist - UM to join their team. This role is responsible for facilitating, coordinating, and approving medically necessary reviews in accordance with established criteria. The Physical Therapist will evaluate clinical information, apply medical necessity criteria, and provide consultation to ensure appropriate utilization and timely, accurate determinations, notifications, and reconsiderations. The work involves making a tangible impact on the lives of individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/developmental disabilities.

Requirements

Master’s degree in Physical Therapy
One (1) year of utilization management or utilization review experience, including acute inpatient care, outpatient care, rehabilitation, behavioral health, compliance, or use of evidence-based clinical decision support tools (e.g., MCG, InterQual).
Fully licensed by the North Carolina Board of Physical Therapy Examiners as a Physical Therapist.
Must have a valid driver’s license.
Must reside within North Carolina.
Must be able to travel within catchment as required.

Nice To Haves

Clinical experience in a managed care organization, health plan or hospital setting.
Utilization Management certification or equivalent certification.

Responsibilities

Perform medical reviews to determine medical necessity and appropriate level of care.
Interpret clinical documentation, diagnoses, and treatment plans to support determinations.
Conduct clinical assessments and provide recommendations to support care planning and member needs.
Perform clinical triage and collaborate with internal and external care teams to develop and implement care plans.
Document clinical reviews, rationale, and determinations within required timeframes and systems.