Clinical Analyst Level I

MedRisk; Mandaluyong; On-site; PHP 279,000 - 502,000; Full time

Job summary

MedRisk is seeking a Clinical Analyst in the Philippines to support clinical oversight of workers’ compensation cases focused on Certified Hand Therapy, Occupational Therapy, and Physical Therapy across telerehab programs.

The role involves collecting and reviewing clinical data, coordinating with US-based providers, and ensuring accurate documentation for reviews. Requires a valid Philippines Physical Therapy license and 2–3 years of outpatient clinic experience.

Qualifications

• Must hold a current Philippines Physical Therapy License.
• Experience: 2-3 years of outpatient hospital clinic setting strongly preferred.
• Knowledgeable of current physical medicine treatments.
• Excellent verbal and written communication skills.
• Organizational skills, prioritization, problem-solving and decision making skills are required.
• Ability to multi-task in a fast paced environment.
• Not required, but desired: current US Physical Therapy license and/or Doctor of Physical Therapy degree.
• Experience in utilization review, case management, quality improvement and/or managed care is desired.

Responsibilities

• Clinical Oversight: Confirm attendance of initial evaluation (IE) and receipt of IE Report.
• Reviews documentation and updates cases with accurate clinical information, including ICD codes, Date of Surgery, Clinical Guidelines, ROM/Strength measurements.
• Initiates review for requested service upon referral; review types include Continued Authorization and Internal Clinical Reviews.
• Obtains, compiles, proofs and processes information from providers/adjusters to aid final determination of a clinical reviewer.
• Reviews all assigned cases to provide efficient, cost-effective and quality utilization review services.
• Teleservices: Opens new Telerehab cases and schedules injured workers for Telerehab.
• Manages department calls through the Telerehab Queue; handles inbox and communications.
• Processes continued authorization for Telerehab cases including communication with physician offices and adjusters.
• Performs other Teleservices duties as assigned.
• Overall Duties: Documents all pertinent clinical patient information and actions into case notes.
• Complies with policies and procedures.
• Assists manager and team in quality improvement projects and trainings.
• Meets quality management standards and works within licensure scope.
• Completes other duties and projects as assigned.

Skills

Verbal communication

Written communication

Organizational skills

Multi-tasking

Problem solving

Interpersonal skills

Analytical skills

Education

Philippines Physical Therapy License

Doctor of Physical Therapy

Tools

Microsoft Office

Zoom

Job description

Job Description:

Position Summary

The primary role of the Clinical Analyst position is to assist in the clinical processes associated with clinical oversight of worker’s compensation cases. Focus is on Certified Hand Therapy, Occupational Therapy, Pool Therapy, Physical Therapy, Word Conditioning, Work Hardening, and TeleServices programs. The Analyst has the potential to participate in the collection of non-clinical and clinical data, collection of necessary documentation for clinical review, and complete clinical reviews, which requires evaluation and interpretation of clinical information. When assisting in Teleservices, the Analyst will be involved with activities, which allows the injured worker to move through the program from scheduling for the initial visit through discharge from services. All areas the Clinical Analyst participates in may require calls to US-based MD/therapy offices with discussion with the front office staff and/or the treating therapist. Calls to Patients may occur in areas of the TeleServices program.

Primary Duties & Responsibilities

Clinical Oversight:

Confirming attendance of initial evaluation (IE) and receipt of IE Report

Reviews documentation and updates cases with accurate clinical information, including but not limited to ICD codes, Date of Surgery, Clinical Guidelines, ROM/Strength measurements

Initiates review for requested service upon referral o Review types include Continued Authorization and Internal Clinical Reviews

Obtains, compiles, proofs and processes information received from providers/adjusters to aid in the final determination of a clinical reviewer.

Reviews all assigned cases to provide efficient, cost-effective and quality utilization review services.

Teleservices:

Opens new Telerehab cases in the system and participates in scheduling injured workers for Telerehab

Manages phone calls coming into department through the Telerehab Queue (internal and external calls)

Monitors and handles Telerehab inbox including email, voicemail and fax communications for Teleservices team

Participates in processing continued authorization for Telerehab cases including communication with physician offices and adjusters

Handles other Teleservices duties as assigned

Overall Duties:

Documents all pertinent clinical patient/case information and actions into the case notes.

Complies with all established policies and procedures

Assists manager and team in quality improvement projects to provide instructive feedback to practitioners within scope

Attends meetings and trainings.

Meets quality management standards.

Performs activities within the scope of professional licensure.

Completes other duties and projects as assigned.

Qualifications

Must hold a current Philippines Physical Therapy License

Experience: 2-3 years of outpatient hospital clinic setting strongly preferred

Knowledgeable of current physical medicine treatments

Excellent verbal and written communication skills

Organizational skills, prioritization, problem-solving and decision making skills are required

Ability to multi-task in a fast paced environment

Must be computer literate and be able to use the keyboard accurately. Experience with Microsoft Office and Zoom app are desired.

Strong analytical and interpersonal skills are also required.

Not required, but desired: current US Physical Therapy license and/or Doctor of Physical Therapy degree

Experience in utilization review, case management, quality improvement and/or managed care is desired