Clinical Reviewer, Occupational Therapy

Evolent; United States; Remote; USD 10,000 - 60,000; Part time

Job summary

Join a forward-thinking healthcare organization as a Clinical Reviewer in Occupational Therapy. This role allows you to make a significant impact on patient outcomes while enjoying a flexible work-life balance. Collaborate with a dedicated team and utilize your expertise in clinical review to ensure quality care standards are met. With a focus on continuous learning and a culture of inclusion, this is an excellent opportunity for professionals seeking to thrive in a supportive environment. Embrace the chance to contribute to meaningful healthcare improvements while enjoying comprehensive benefits and a rewarding career path.

Benefits

Comprehensive Health Insurance

Work-life Balance

Flexible Work Hours

Qualifications

• Current, unrestricted state licensure as an Occupational Therapist.
• 5+ years of clinical experience required.

Responsibilities

• Review charts and analyze clinical records to approve services.
• Conduct audits to ensure guidelines are properly applied.

Skills

Interpersonal Skills

Communication Skills

Basic Computer Skills

Education

Degree from an Accredited Occupational Therapy Program

National Certification Exam

Job description

Join to apply for the Clinical Reviewer, Occupational Therapy role at Evolent.

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Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with complex and costly health conditions. Working across specialties and primary care, we aim to connect the fragmented healthcare system and ensure people receive the same level of care and compassion we would want for our loved ones.

Our employees enjoy work/life balance, flexibility, and autonomy to accomplish their goals. We believe people do their best work when supported to live their best lives and feel welcome to bring their whole selves to work. Diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

As an Occupational Therapist, Initial Clinical Reviewer, you will be a key member of the utilization management team. This role offers a meaningful way to make a difference in patients' lives in a non-clinical environment. You will enjoy better work-life balance on a collaborative team that values continuous learning and aims to improve health outcomes.

Collaboration Opportunities:

• Interact with leadership, management staff, physicians, and other ICRs as needed.

Job Summary

Functions in a clinical review capacity to evaluate cases that do not pass initial authorization, promoting a team approach with call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs).

Job Description

• Review charts and analyze clinical records to approve services meeting review criteria.
• Monitor quality of care standards within the provider network and clinical staff.
• Conduct audits to ensure guidelines are properly applied.
• Refer cases requiring physician review or make denial decisions where permitted by state laws.
• Communicate with medical staff to obtain clinical information, notify of approvals/denials, and provide rationale.
• Provide excellent customer service through professional communication, adhering to timeframes and documentation standards.
• Participate in ongoing training to ensure compliance and quality performance.

Required Experience:

• Current, unrestricted state licensure as an Occupational Therapist.
• Degree from an accredited program and passing the national certification exam.
• 5+ years of clinical experience.
• Strong interpersonal and communication skills.
• Basic computer skills, including talking and typing simultaneously.

Technical Requirements:

High-speed internet (>10 Mbps) and ability to connect directly to the home router are required. These requirements may change as office reopenings occur.

Evolent is an equal opportunity employer. For accommodations, contact [e-mail].

The salary range is $38-40 per hour, with potential bonuses based on performance. We offer comprehensive benefits, including health insurance. Compensation varies based on skills and experience.

Additional Information

• Seniority level: Mid-Senior level
• Employment type: Part-time
• Job function: Healthcare, Research, Analysis, IT
• Industry: Hospitals and Healthcare