Senior Clinical Review Specialist 3

Enlyte • UNAVAILABLE, UNAVAILABLE

5d • Remote

About The Position

The Senior Clinical Review Specialist Level 3 is a clinical leader and subject matter expert within the Clinical Oversight Team at Apricus. This role involves overseeing the review of complex physical therapy services for injured workers to ensure high-quality care and appropriate treatment, with primary responsibility for clinical strategy, policy development, and team management. You will provide strategic clinical guidance, develop clinical standards, and ensure organizational compliance with clinical best practices. This position is available as a remote work opportunity with expectations for maintaining confidentiality of company and customer information.

Requirements

• Degree in Physical Therapy with active license as Physical Therapist or Physical Therapist Assistant in the United States.
• Experience 3+ years in outpatient therapy setting
• Exceptional communication skills, both written and verbal.
• Ability to provide comprehensive review reports for clients
• Demonstrate ability to meet metrics for reviews case load
• Excellent organizational skills with ability to prioritize work effectively
• Proficiency with company software and equipment

Responsibilities

• Oversee comprehensive reviews of highly complex, precedent-setting, and atypical physical or occupational therapy evaluation and treatment documentation
• Perform Peer-to-Peer communication with treating or supervising PTs and OTs via phone and/or email to review therapy care plans for injured workers covered by Workers Compensation claims, including all escalated, disputed, or high-impact cases
• Utilize state and national disability guidelines to assess duration of care and provide clinical recommendations for ongoing therapy or discharge readiness
• Prepare detailed reports and clinical summaries with written support of recommendations for clients
• Maintain communication with nurse case managers and other claim stakeholders as needed
• Collaborate with operations and clinical admin staff to ensure appropriate authorization
• Perform provider follow up regarding authorization and/or clinical recommendations
• Provide clinical oversight, quality assurance review, and approval authority for all peer work
• Lead and mentor the entire Clinical Review Specialist team, including Level 1 and Level 2 Senior Specialists
• Develop, implement, and refine clinical review protocols, guidelines, and best practices
• Lead comprehensive quality assurance initiatives, clinical audits, and continuous improvement programs
• Serve as primary escalation point and final authority for complex clinical determinations
• Represent Clinical Oversight Team in cross-functional strategic initiatives and policy development
• Ensure organizational compliance with evolving state and federal clinical standards

Benefits

• Medical
• Dental
• Vision
• Health Savings Accounts / Flexible Spending Accounts
• Life and AD&D Insurance
• 401(k)
• Tuition Reimbursement

What This Job Offers

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