Licensed Clinical Review Specialist

Job Summary

A company is looking for a Clinical Review Support Specialist (Remote).

Key Responsibilities

• Support medical necessity review determinations and perform outreach calls to practitioners
• Clarify provider requests and facilitate clinical review through coordination among evaluators
• Collaborate with management on clinical program development and participate in quality workgroups

Required Qualifications

• Professional degree as a Physical Therapy Assistant from an accredited institution
• Current, unrestricted license to practice in the healthcare specialty
• Minimum of 5 years of clinical experience, with care coordination experience preferred
• Understanding of therapy evidence-based guidelines and managed therapy services
• Advanced training or certification in relevant areas is preferred