State Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer, Physical Therapy.

Key Responsibilities

• Evaluate cases that do not pass the authorization approval process and collaborate with call center staff
• Review clinical records to approve services meeting review criteria and conduct audits to ensure guideline compliance
• Communicate with medical office staff regarding approvals and denials, providing clinical rationale and maintaining documentation

Required Qualifications

• Current, unrestricted state licensure as a Physical Therapist
• Physical therapy degree from an accredited program and passing of the national certification examination
• Preferred 5+ years of clinical experience
• No history of disciplinary or legal action by a state medical board
• Not under current exclusion or sanction by any state or federal health care program