Physical Therapist Case Manager - Remote

UnitedHealth Group • Eden Prairie, MN • 4h ago

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Hours: Monday through Friday 8AM-4:30PM in your time zone

Clinical reviewers at Optum Physical Health are part of a team focused on improving clinical outcomes for our members and promoting the current best evidence in the utilization of therapy services. The role as a clinical reviewer is focused on reviewing clinical submissions/prior authorizations as well as interacting with providers regarding their questions on the clinical submission process and clinical review outcomes.

Primary Responsibilities:

Make determinations of medical necessity/clinical appropriateness of treatment

Assist in the development and implementation of clinical policy, guidelines and applications

Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community

Be knowledgeable on and apply all necessary regulatory requirements for assigned regions

Responsible for appropriate utilization management (prospective, concurrent and retrospective) and implementation of healthcare affordability initiatives in all the UnitedHealthcare regions

Take initiative to control utilization trends without losing sight of quality and outcomes for health care consumers

Implement specific strategies that improve the quality and outcomes of care for consumers

Support many @types of health plan structures (Fully Insured, Medicare, Medicaid, Workers Compensation and Auto liability)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Active and unrestricted license to practice Physical Therapy in the state of residence

5+ years of experience working as a Physical Therapist in an Adult Outpatient Orthopedic environment OR 5+ years of experience working in a Pediatric Outpatient environment

Experience with and the ability to interpret guidelines, research, etc. in the @context of traditional Physical Therapy practice

Experience with and the ability to be consultative with others including supervisory, clinical and non-clinical professionals

Proficiency in MS Office Suite Tools (Outlook, Word, Excel, MS Teams)

Proficient knowledge of practice guidelines, including office procedures, current research and scope of practice

Dedicated, distraction free workplace with access to high speed internet from home (Broadband cable, Fiber or DSL)

Preferred Qualifications:

3+ years of clinical experience performing case review

1+ years of experience as a Physical Therapist working with the Pediatric population

Experience in a managed care environment (health plan, medical group, etc.)

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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