Hours: Monday through Friday 8AM-4:30PM in your time zone
Clinical reviewers at Optum Physical Health are part of a team focused on improving clinical outcomes for our members and promoting the current best evidence in the utilization of therapy services. The role as a clinical reviewer is focused on reviewing clinical submissions/prior authorizations as well as interacting with providers regarding their questions on the clinical submission process and clinical review outcomes.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Make determinations of medical necessity/clinical appropriateness of treatment
- Assist in the implementation of clinical policy, guidelines and applications
- Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community
- Be knowledgeable on and apply all necessary regulatory requirements for assigned regions
- Responsible for appropriate utilization management (prospective, concurrent and retrospective) and implementation of healthcare affordability initiatives in all the UnitedHealthcare regions
- Take initiative to control utilization trends without losing sight of quality and outcomes for health care consumers
- Implement specific strategies that improve the quality and outcomes of care for consumers
- Support many types of health plan structures (Fully Insured, Medicare, Medicaid)
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- Active and unrestricted license to practice Physical Therapy in the state of residence
- 5+ years of experience working as a Physical Therapist in an Adult Outpatient Orthopedic environment
- Experience with and the ability to interpret guidelines, research, etc. in the context of traditional Physical Therapy practice
- Experience with and the ability to be consultative with others including supervisory, clinical and non-clinical professionals
- Proficient knowledge of practice guidelines, including office procedures, current research and scope of practice
- Proficiency in MS Office Suite Tools (Outlook, Word, Excel, MS Teams)
- Dedicated, distraction free workplace with access to high speed internet from home (Broadband cable, Fiber or DSL)
Preferred Qualifications:- 5+ years of clinical experience performing case review
- Experience in a managed care environment (health plan, medical group, etc.)
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
