Description - Internal
Reviewer - Therapy Services - Position is for - PTs, OTs
Work hours as follows :
- HST 6:30 AM - 3 PM
- AKST 8:30 AM - 5 PM
- PST 9:30AM - 6PM
- MST 10:30AM - 7PM
- CST 11:30AM - 8PM
- EST 12:30PM - 9PM
The Reviewer - Therapy Services is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) 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 time frames.
- Requires graduate of a college level program in Physical Therapy, Occupational Therapy, 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, Occupational Therapist, in the state that you reside.
- Certification and/or licensure appropriate to field of specialty is required.
- Pediatric Developmental Delay and/or Outpatient Orthopedic experience
Applicable to Colorado Applicants Only
Hourly Pay Range*: $27.54/hr - $36.14/hr
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
* The hourly or salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
For URAC accredited areas the following applies:
- Requires current, active, unrestricted license in occupational, speech, or physical therapy to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States.
- Current, active, unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state or territory of the United States.
- Unless expressly allowed by state or federal law or regulation, are located in a state or territory of the United States when conducting a peer clinical review.
For URAC accredited areas, the following professional competencies apply:
- Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.