Perform utilization review of authorization requests regarding specialty therapy services for members
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
Refer members to case management as appropriate based on service request assessment
Provide clinical recommendations for any adverse therapy determination
Provide support for specialty therapy providers, including assistance with clinical trainings
Provide clinical expertise to multi-functional areas within organization to support provider relations and operations
Performs other duties as assigned
Complies with all policies and standards

Master’s degree in area of specialty therapy or equivalent experience
3+ years of experience providing therapy services in healthcare or home health settings
Adult and/or Pediatric clinical experience preferred
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
Advanced clinical knowledge and ability to assess member needs in context of treatment plans and goals
Strong communication, strong attention to detail, organizational and time management skills
Microsoft Office applications (Excel, Outlook, Word, OneNote) and the ability to use multiple avenues of digital communication (e.g. instant messaging, email, phone, video conferencing)
Comfortable using digital video conferencing platforms (Zoom, MS Teams) is required.

Utilization Specialty Therapist

Key skills