Clinical Review Therapist - Physical Health

Centene Corporation • Wichita Falls, TX • 18h ago

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

NOTE: Texas - Statewide Candidates will be considered and required to have a current OT, PT, or CCC-SLP license issued by the state of Texas

Work Schedule: Monday - Friday: 8 am - 5 pm (CST)

Position Purpose: Performs clinical reviews of clinical therapy services and/or durable medical equipment to members based on service request assessments and provides clinical expertise based on practice standards. Works with senior management to identify ways to improve the review and execution of therapy services based on clinical reviews of service request assessments.

Performs utilization reviews of service requests regarding specialty therapy services and/or durable medical equipment for members based on best practice and documentation standards by the national therapy associations and organizational policies

Provides recommendations for therapy determinations and refers members to care management, as appropriate, based on service request assessments

Works with Utilization and Care Management teams and healthcare providers to ensure members are receiving the appropriate care and treatment

Expands therapy specialty knowledge and works with senior management to identify areas of improvement with therapy services and/or durable medical equipment for members

Assists with providing education including developing clinical trainings, consultations, and guidance related to therapy authorizations and/or durable medical equipment

Provides feedback to leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies

Performs other duties as assigned

Complies with all policies and standards

Education/Experience: Requires a Bachelor's degree and minimum of 2 - 4 years of related specialty therapy experience (e.g. OT, PT, and SLP).

Preferred Education/Experience:

· Master's degree in area of specialty therapy and 5+ years of experience providing therapy services in-patient, outpatient, home health, and/or managed care settings preferred.

· Clinical knowledge of clinical therapy services, durable medical equipment, and assisted therapy devices preferred.

· Experience with Adult and Pediatric Therapy preferred

· Advanced clinical knowledge and ability to assess member needs in @context of treatment and therapy authorizations

· Knowledge of therapy regulations and guidelines preferred

· Knowledge of utilization management processes preferred

· Role requires adaptability and flexibility to business changes, distribution of work, training, and technology processes

· Strong communication, strong attention to detail, organizational and time management skills

· Microsoft Office applications (Co-Pilot, Excel, Outlook, Word, OneNote) and the ability to use multiple avenues of digital communication (e.g. instant messaging, email, phone, video conferencing)

· Comfortable using digital video conferencing platforms (Zoom, MS Teams)

Licenses/Certifications: Required

· OT-Occupational Therapist- Registered required or

· PT - Physical Therapist required or

· CCC-SLP - Speech-Language Therapist required and must have an active Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association.

NOTE: Texas - Statewide Candidates will be considered and required to have a current OT, PT, or CCC-SLP license issued by the state of Texas

Pay Range: $30.58 - $55.09 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Similar Jobs

NP-Mental Health

Veterans Affairs, Veterans Health Administration • Wichita Falls, TX • 1w ago

Hospital & Medical

Summary Might be eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific eligibility requirements per VHA policy and submit your EDRP application wit...

1w ago

Go to Apply

Physician Assistant- Primary Care

Veterans Affairs, Veterans Health Administration • Wichita Falls, TX • 1w ago

Hospital & Medical

Summary This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific eligibility requirements per VHA policy and submit your EDRP applica...

1w ago

Go to Apply

Nurse Practitioner- Primary Care

Veterans Affairs, Veterans Health Administration • Wichita Falls, TX • 1w ago

Hospital & Medical

Summary The Advanced Practice Nurse (APN) Certified Nurse Practitioner (NP) practices in Primary Care Service to provide a full range of services emphasizing quality, timeliness, and the advancement of the Veterans Affai...

1w ago

Go to Apply

Physician- Primary Care

Veterans Affairs, Veterans Health Administration • Wichita Falls, TX • 1w ago

Hospital & Medical

1w ago

Go to Apply

Electrician - Interior

ASRC Federal Holding Company • Wichita Falls, TX • 2h ago

Manufacturing & Warehouse

ASRC Federal is a leading government contractor furthering missions in space, public health and defense. As an Alaska Native owned corporation, our work helps secure an enduring future for our shareholders. Join our team...

2h ago

Go to Apply

Shipping and Receiving Clerk

EXPRESS EMPLOYMENT PROFESSIONALS • Wichita Falls, TX • 22h ago

Management & Administrative

::: {mce-=""} Shipping and Receiving Clerk ::: ::: {mce-=""} South Pharr ::: ::: {mce-=""} Mon-Fri 9am-6:30pm ::: ::: {mce-=""} Rotating Saturdays 9am-1pm ::: ::: {mce-=""} $11/hour ::: ::: {mce-=""} ::: ::: {mce-=""} ::...

22h ago

Go to Apply

Millwright

TRIANGLE BRICK COMPANY • Henrietta, TX • 1d ago

Manufacturing & Warehouse

General Summary: Millwright The Millwright is highly skilled and adaptable, with over four years of experience installing, maintaining and repairing mechanical equipment in industrial settings. This individual will have...

1d ago

Go to Apply

Manufacturing

TRIANGLE BRICK COMPANY • Henrietta, TX • 1d ago

Manufacturing & Warehouse

Responsibilities of all Clay County Triangle Brick Company employees: Safety of self and all team members Regular and reliable attendance Dedicated to making quality products Actively participate in the appearance and up...

1d ago

Go to Apply

Sales Intern

Nexstar Media Group • Wichita Falls, TX • 1d ago

Sales & Marketing

Position Overview:KFDX in Wichita Falls, TX is seeking motivated and enthusiastic college students for an internship in our Sales Department. This is a unique opportunity to gain hands-on experience in media sales, marke...

1d ago

Go to Apply

Senior Electrical Engineer

ASRC Federal Holding Company • Wichita Falls, TX • 3d ago

IT & Engineering

3d ago

Go to Apply

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