Licensed Clinical Review Therapist

Job Summary

Working remotely on a full-time basis, the Senior Clinical Review Therapist will perform complex clinical reviews of therapy services and durable medical equipment, providing clinical expertise and recommendations to improve service execution based on assessments and practice standards.

Key responsibilities

• Assesses and performs utilization reviews of service requests for complex specialty therapy services and durable medical equipment
• Collaborates with the Utilization and Care Management team and healthcare providers to ensure appropriate member care and treatment
• Develops clinical training and provides education related to therapy authorizations and provisions

Required qualifications

• Bachelor's degree and 4-6 years of related experience
• Licensure as a Physical Therapist, Occupational Therapist, or Speech Therapist required
• Advanced clinical knowledge of therapy services and durable medical equipment preferred
• Strong knowledge of therapy regulations and guidelines preferred
• Familiarity with utilization management processes preferred