Utilization Specialty Therapist

Summary:

• Perform utilization review of authorization requests regarding specialty therapy services for members, including speech language, occupational, and physical therapy across the identified regions and products.
• Assist with training and network management support for therapy providers.

Responsibilities:

• Perform detailed review of therapy service requests based on evidenced-based practice, documentation standards as indicated by the national therapy associations, and organizational policies.
• Refer members to case management as appropriate based on service request assessment.
• Provide clinical recommendations for any adverse therapy determination.
• Provide clinical expertise based on shared practice standards regarding sub-specialty therapy practice to peers.
• Provide support for specialty therapy providers, including assistance with clinical trainings, consultation, and guidance on matters related to therapy authorization and provision.
• Provide clinical expertise to multi-functional areas within the organization to support provider relations and operations.

Requirements:

• Master’s degree in area of specialty therapy or equivalent experience.
• Minimum 3 years of experience providing therapy services in healthcare or home health settings.
• Current state license in Physical Therapy, Occupational Therapy, or Speech-Language Therapy.
• Speech-Language Therapist must have an active Certificate of Clinical Competence from the American Speech-Language-Hearing Association.

Preferred Skills:

• Pediatric clinical experience preferred.