Occupational Therapist providing lymphedema therapy at ProHealth Care in Waukesha. Evaluating patients and establishing treatment plans in community - focused outpatient settings.
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Hybrid Physical Therapist, Occupational Therapist – Therapy Services Reviewer
Posted 2 weeks ago
About the role
- Reviewing medical records to assess therapy service requests at Elevance Health. Ensure compliance with regulations and maintain high quality and productivity standards.
Responsibilities
- The Therapy Services Reviewer is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy) were medically necessary and filed appropriately.
- Follows the system guidelines that makes decisions on approval for care for a patient.
- Processes system generated decisions for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction.
- Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements.
- Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary.
- Acts as a resource for internal and external customers.
- May participate in intradepartmental teams, projects, and initiatives.
- Maintains quality and productivity standards and ensures reviews are conducted within required timeframes.
Requirements
- Requires graduate of a college level program in physical therapy, occupational therapy, or speech language pathology or an accredited two-year program for a Physical Therapist Assistant, Occupational Therapist Assistant, or Speech Language Pathologist Assistant and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state required.
- Certification and/or licensure appropriate to field of specialty is required.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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