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.
Education/Experience: Master’s degree in area of specialty therapy or equivalent experience. 3+ years of experience providing therapy services in healthcare or home health settings. Pediatric clinical experience preferred.
Licenses/Certifications: 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.
Job ID 1123746