Position Purpose: Authorize and review utilization of outpatient and home health occupational, physical and speech therapy.
Authorize, direct and monitor care being treated in physical, occupational and speech therapy for medical necessity and appropriateness of care
Review plans of care to ensure functional outcomes and use of clinical practice guidelines
Ensure compliance with performance measures in regards to appeals and denials
Provide support and training to rehabilitation providers, including real
time clinical training, consultation and guidance on matters related to service authorization, provision, and evidence
Identify areas of concern with regards to deficiencies in the Plan of Care and make appropriate referrals and outreach to assist in improved treatment outcomes
Interact with Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases
Education/Experience: Master's degree in Speech-Language Pathology, Occupational Therapy, or Physical Therapy. 3+ years of specialty therapy experience in healthcare, home health, or school settings.
License/Certification: Current Certification/Licensure in Speech–Language Pathology, Occupational Therapy, or Physical Therapy in the State of Practice. Speech-Language Pathologists must also possess an active Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association (ASHA).