Medicare Advantage UM Reviewer Physical Therapist
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About The Position
The Clinical Utilization Reviewer is responsible for facilitating care for members who may have complex healthcare needs, authorizing medically necessary services at the right level of care to promote optimal health. This position is self-directed and works independently and collaboratively to facilitate care using clinical skills, principles of managed care, nationally recognized medical necessity criteria, and company medical policies to conduct reviews that promote efficient and medically appropriate use of the member's benefit to provide the best quality care. This role is eligible for our eWorker, Mobile, and Resident personas. This position can be fully remote, with a 1-2x/month meeting in our Hingham, MA office. Hours of work: 8:30a - 4:30p EDT.
