Massachusetts Licensed Occupational Therapist

Job Summary

To support clinical coverage reviews for MassHealth LTSS, the remote Massachusetts Licensed Occupational Therapist will perform pre-service clinical coverage determinations, attend appeal hearings, and collaborate with team members to ensure compliance with medical necessity guidelines.

Key responsibilities:

• Assess the appropriateness of services for prior authorizations based on documentation and guidelines
• Participate in appeal hearings and provide clinical mentorship to junior reviewers
• Maintain compliance with MassHealth clinical guidelines and support operational efficiency through collaboration

Required qualifications:

• Current Massachusetts Occupational Therapist licensure
• Experience with clinical coverage reviews and prior authorization processes
• Ability to work independently and collaboratively in a remote setting
• Strong understanding of MassHealth policies and medical necessity guidelines
• Proficiency in clinical documentation and quality assurance practices