About the position
The Therapist Reviewer Sr will be responsible for the review of medical records, including more complex cases, to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) are medically necessary and filed appropriately. This role is crucial in ensuring that all therapy service requests meet the necessary medical and regulatory standards, thereby contributing to the overall quality of care provided to patients. In this position, the Therapist Reviewer will apply their professional therapy knowledge, along with an understanding of government regulations and medical policies, to conduct thorough medical reviews. They will make determinations for authorization requests, ensuring compliance with all contract requirements and operational unit goals. This role requires maintaining up-to-date knowledge of regulations and requirements through continuous review of current policies, which is essential for accurate decision-making. The Therapist Reviewer Sr will document their findings meticulously, develop analyses, and submit reports to the appropriate departments in accordance with government regulations. They will also be responsible for researching and obtaining additional data as needed, consulting with clinical reviewers and medical directors when necessary. Acting as a resource for both internal and external customers, the Therapist Reviewer will participate in or lead intradepartmental teams, projects, and initiatives, maintaining quality and productivity standards while ensuring that reviews are conducted within required timeframes.
Responsibilities
- Review medical records to determine the medical necessity of therapy service requests.
- Apply professional therapy knowledge and government regulations to medical reviews.
- Document findings and develop analyses for submission to appropriate departments.
- Research and obtain additional data as needed for complex cases.
- Consult with clinical reviewers and medical directors when necessary.
- Act as a resource for internal and external customers regarding therapy services.
- Participate in or lead intradepartmental teams and projects.
- Maintain quality and productivity standards in reviews.
- Ensure reviews are conducted within required timeframes.
Requirements
- Graduate of a college level program in physical therapy, occupational therapy, or speech language pathology.
- Minimum of 3 years of clinical experience in relevant fields.
- Current active unrestricted license as a physical therapist, occupational therapist, or speech language pathologist in applicable state required.
- Licensure appropriate to field of specialty as 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) with matching
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
