Therapist Reviewer, Sr
- KS-TOPEKA, 1010 SW TYLER ST,, United States of America
- KS-OLATHE, TBD
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.
How you will make a difference:
- Applies professional therapy, government regulation and medical policy knowledge to medical review, and makes determinations for authorization requests, meeting all contract requirements, processes and operational unit goals to ensure customer satisfaction.
- Maintains knowledge of regulations and requirements through review of current regulations and/or policies.
- 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.
- Participates in or leads intradepartmental teams, projects and initiatives. Maintains quality and productivity standards, and ensures reviews are conducted within required timeframes.
Minimum Requirements:
- Requires a graduate of a college level program in physical therapy, occupational therapy, or speech language pathology and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- 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.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
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.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
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 elevancehealthjobssupport@elevancehealth.com for assistance.