Senior Clinical Review Therapist - Physical Health
About The Position
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. POSITION IS REMOTE IDEAL CANDIDATE WILL BE PT or OT AND HAVE EXPERIENCE WORKING WITH PEDIATRIC AND/OR ADULT POPULATION Position Purpose: Performs complex clinical reviews of clinical therapy services and/or durable medical equipment to members based on service request assessments and provides clinical expertise based on practice standards. Applies clinical knowledge and provides recommendations to senior management team to identify ways to improve the review and execution of therapy services based on clinical reviews of service request. Assesses and performs utilization reviews of service requests regarding complex specialty therapy services and/or durable medical equipment for members based on best practice and documentation standards by the national therapy associations and organizational policies Manages and collaborates works with Utilization and Care Management team and healthcare providers to ensure members are receiving the appropriate care and treatment Applies advanced clinical therapy specialty knowledge and identifies areas of concern and improvement with therapy services and/or durable medical equipment for members Provides education including developing clinical trainings, consultations, and guidance related to therapy authorizations and provisions Partners with leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies Provides feedback to leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies Performs other duties as assigned Complies with all policies and standards
Requirements
- Requires a Bachelor's degree and 4 – 6 years of related experience.
- Advanced clinical knowledge of clinical therapy services and/or durable medical equipment preferred.
- Strong knowledge of therapy regulations and guidelines preferred.
- Strong knowledge of utilization management processes preferred.
- PT - Physical Therapist required or OT - Occupational Therapist – Registered required or ST - Speech Therapist required
Responsibilities
- Performs complex clinical reviews of clinical therapy services and/or durable medical equipment to members based on service request assessments and provides clinical expertise based on practice standards.
- Applies clinical knowledge and provides recommendations to senior management team to identify ways to improve the review and execution of therapy services based on clinical reviews of service request.
- Assesses and performs utilization reviews of service requests regarding complex specialty therapy services and/or durable medical equipment for members based on best practice and documentation standards by the national therapy associations and organizational policies
- Manages and collaborates works with Utilization and Care Management team and healthcare providers to ensure members are receiving the appropriate care and treatment
- Applies advanced clinical therapy specialty knowledge and identifies areas of concern and improvement with therapy services and/or durable medical equipment for members
- Provides education including developing clinical trainings, consultations, and guidance related to therapy authorizations and provisions
- Partners with leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies
- Provides feedback to leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies
- Performs other duties as assigned
- Complies with all policies and standards
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
