Utilization Specialty Therapist

Role Overview

• 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 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
• Performs other duties as assigned

Requirements

• 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
• 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

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules