Utilization Specialty Therapist

Centene Corporation

1d•$34 - $61

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. Superior Health Plan - Specialty Therapy Services NOTE: Candidates must reside in the state of Texas Position Purpose: Perform utilization review of authorization requests regarding specialty therapy services for members, including speech language, occupational, and physical therapy across the identified regions and products. Assist with training and network management support for therapy providers. Perform detailed review of therapy service requests based on evidenced based practice, documentation standards as indicated by the national therapy associations, and organizational policies. Refer members to case management as appropriate based on service request assessment. Provide clinical recommendations for any adverse therapy determination. Provide clinical expertise based on shared practice standards regarding sub-specialty therapy practice to peers. Provide support for specialty therapy providers, including assistance with clinical trainings, consultation and guidance on matters related to therapy authorization and provision. Provide clinical expertise to multi-functional areas within organization to support provider relations and operations. Performs other duties as assigned Complies with all policies and standards

Requirements

Master’s degree in area of specialty therapy or equivalent experience.
3+ years of experience providing therapy services in healthcare or home health settings.
Current state license in Physical Therapy, Occupational Therapy or Speech-Language Therapy.
Speech-Language Therapist must have an active Certificate of Clinical Competence from the American Speech-Language-Hearing Association.

Nice To Haves

Pediatric clinical experience preferred.

Responsibilities

Perform utilization review of authorization requests regarding specialty therapy services for members, including speech language, occupational, and physical therapy across the identified regions and products.
Assist with training and network management support for therapy providers.
Perform detailed review of therapy service requests based on evidenced based practice, documentation standards as indicated by the national therapy associations, and organizational policies.
Refer members to case management as appropriate based on service request assessment.
Provide clinical recommendations for any adverse therapy determination.
Provide clinical expertise based on shared practice standards regarding sub-specialty therapy practice to peers.
Provide support for specialty therapy providers, including assistance with clinical trainings, consultation and guidance on matters related to therapy authorization and provision.
Provide clinical expertise to multi-functional areas within organization to support provider relations and operations.
Performs other duties as assigned
Complies with all policies and standards