Therapy Services Reviewer

Elevance Health • Florida, Florida • 1w ago

The Therapy Services Reviewer is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy) were medically necessary and filed appropriately.

Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

How you will make an impact:

· Follows the system guidelines that makes decisions on approval for care for a patient.

· Processes system generated decisions for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction.

· Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements.

· Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary.

· Acts as a resource for internal and external customers.

· May participate in intradepartmental teams, projects, and initiatives.

· Maintains quality and productivity standards and ensures reviews are conducted within required timeframes.

Minimum Requirements:

· Requires graduate of a college level program in physical therapy, occupational therapy, or speech language pathology or an accredited two-year program for a Physical Therapist Assistant, Occupational Therapist Assistant, or Speech Language Pathologist Assistant and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background.

· Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state required. Certification and/or licensure appropriate to field of specialty is required.

Preferred Skills, Capabilities and Experiences:

Physical Therapist or Occupational Therapist

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Similar Jobs

Physical Therapist (PT) for Home Health

FeldCare Connects • Florida, Florida • 10h ago

Hospital & Medical

This position is for an Independent Contractor to serve the West Beach area specifically. FeldCare Connects is currently seeking a self-motivated Physical Therapist to deliver premier excellence of care and is enthusiast...

10h ago

Go to Apply

Clinical Specialist - Government Accounts - East Region

BD (Becton, Dickinson and Company) • Florida, Florida • 21h ago

Hospital & Medical

Job Description Summary The Clinical Specialist supports BD's Urology & Critical Care (UCC) portfolio across federal healthcare markets, specifically the Department of Veterans Affairs (VA) and the Department of Defe...

21h ago

Go to Apply

Nurse Reviewer I

Elevance Health • Florida, Florida • 4d ago

Hospital & Medical

Nurse Reviewer I Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productiv...

4d ago

Go to Apply

Advanced Practice Nurse Practitioner

Molina Healthcare • Florida, Florida • 4d ago

Hospital & Medical

JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of health care services provided to plan members - targeting improvements in efficiency and satisfaction for m...

4d ago

Go to Apply

Pharmacy Technician (Must be state licensed and nationally certified)

Molina Healthcare • Florida, Florida • 1w ago

Hospital & Medical

JOB DESCRIPTION Job Summary Provides support for pharmacy technician activities. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member...

1w ago

Go to Apply

Medical Director (Medicare)

Molina Healthcare • Florida, Florida • 1w ago

Hospital & Medical

JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and pr...

1w ago

Go to Apply

Certified Nursing Assistant

Help at Home • Florida, Florida • 1w ago

Hospital & Medical

Caregiver Services Inc, a Help at Home company is registering Licensed CNA's in your community TODAY! Start your career and become a hero for someone in your community. Why should you choose Caregiver Services Inc? Build...

1w ago

Go to Apply

AVP, Clinical Operations

Molina Healthcare • Florida, Florida • 1w ago

Hospital & Medical

JOB DESCRIPTION Job Summary Provides strategy and leadership to a team responsible for enterprise clinical operations and program design initiatives. Supports and enables clinicians across Molina to drive desired member...

1w ago

Go to Apply

Field Nurse Practitioner (Multiple Openings in CT)

Molina Healthcare • Florida, Florida • 1w ago

Hospital & Medical

JOB DESCRIPTION Job Summary Provides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nurs...

1w ago

Go to Apply

Medical Director

Molina Healthcare • Florida, Florida • 2w ago

Hospital & Medical

JOB DESCRIPTION Job Summary Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support th...

2w ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.