Utilization Management Physical Therapist at Texas Children's Careers

Bellaire, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

06 Mar, 26

Salary

0.0

Posted On

06 Dec, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Management, Clinical Judgement, Medical Necessity, Provider Education, Assessment, Consultation, Regulatory Guidelines, Communication, Case Management, Quality Indicators, Physical Therapy, Outpatient Services, Home Therapy Services, Authorization Process, Evidence-Based Criteria, Benefit Coverage

Industry

Hospitals and Health Care

Description

We’re looking for a Utilization Management Physical a Therapy Specialist, someone who’s ready to grow with our company. In this position you will provide prior authorization of outpatient and home physical and occupational therapy services requiring authorization. This process includes using clinical judgement for utilization management, application of product benefits, understanding of regulatory requirements, and verification of medical necessity utilizing evidence-based criteria. In addition, provider education is a component of this process. Think you’ve got what it takes? Job Duties & Responsibilities • Assess the treatment plan, clinical information, and medical necessity of all requested services. • Utilizes established criteria to appropriately certify requested services within established timeframe required. • Consults with physicians and therapists regarding member’s history and current care needs on an ongoing basis. • Refers cases failing to meet medical necessity criteria to the medical director or designee for review and disposition. • Conducts timely entry of information into systems and assigns appropriate length of service per established guidelines and communicates authorization numbers to providers and members. • Evaluates benefit coverage and regulatory guidelines pertinent to decision making. • Facilitates provider communication and education. • Liaisons with internal and external managed care staff members. • Assess and refer to potential case management cases. • Ongoing assessment for quality indicators and concerns. Skills & Requirements • Required Degree in Physical Therapy • Preferred Master's degree Physical Therapy • Required PT - Physical Therapist by the Texas Board of Physical Therapy Examiners • 5 years required in Professional physical therapy and/or utilization management experience

Responsibilities

The Utilization Management Physical Therapist will assess treatment plans and clinical information to determine medical necessity for therapy services. They will also consult with healthcare providers and ensure timely communication of authorization decisions.