Reviewer - Therapy Services

About the position

The Reviewer - Therapy Services position at Elevance Health is a remote role responsible for reviewing medical records to assess the medical necessity of therapy service requests, including physical therapy, occupational therapy, and speech-language pathology. The role involves following system guidelines for care approval, documenting findings, and collaborating with clinical reviewers and medical directors as needed. The position requires strong analytical and communication skills, as well as a valid therapy license.

Responsibilities
? Review medical records to determine the medical necessity of therapy service requests.
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? Follow system guidelines for approval decisions regarding patient care.
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? Process authorization requests while meeting contract requirements and operational goals.
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? Document findings and develop analyses for submission to relevant departments.
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? Research and obtain additional data, consulting with clinical reviewers and medical directors when necessary.
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? Act as a resource for internal and external customers.
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? Participate in intradepartmental teams, projects, and initiatives as needed.
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? Maintain quality and productivity standards, ensuring timely reviews.
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? Serve as a call center representative, handling incoming calls and conducting peer-to-peer consultations.

Requirements
? Graduate of a college-level program in physical therapy, occupational therapy, or speech-language pathology, or an accredited two-year program for assistants.
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? Minimum of 1 year of clinical experience in the relevant field.
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? Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech-language pathologist assistant in applicable state required.
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? Certification and/or licensure appropriate to field of specialty is required.

Nice-to-haves
? Strong oral, written, and interpersonal communication skills.
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? Problem-solving and facilitation skills.
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? Current active unrestricted license or certification as a physical therapist, occupational therapist, or speech-language pathologist in applicable state preferred.

Benefits
? Employee stock purchase plan
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? Paid holidays
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? Disability insurance
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? Health insurance
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? Dental insurance
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? 401(k)
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? Paid time off
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? Vision insurance
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? 401(k) matching
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? Life insurance

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