Clinical Reviewer, Physical Therapy

Evolent; Hagåtña Municipality (GU); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading health services organization in Guam seeks a Clinical Reviewer for Physical Therapy to evaluate clinical cases and enhance patient care in a supportive work environment. Ideal candidates will have current state licensure and years of clinical experience to contribute positively to the organization’s mission.

Benefits

Comprehensive health insurance

Flexible work-life balance

Bonus eligibility based on performance

Qualifications

• Current, unrestricted state licensure as a Physical Therapist.
• 5+ years clinical experience preferred.
• Energetic and curious with a passion for quality and value in health care.

Responsibilities

• Reviews charts and analyzes clinical record documentation.
• Monitors quality of care standards.
• Conducts audits to ensure guidelines are applied appropriately.

Skills

Interpersonal skills

Communication skills

Organizational skills

Computer proficiency

Education

Degree in Physical Therapy from an accredited program

Current state licensure as a Physical Therapist

Job description

Overview

Your Future Evolves Here

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

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they’re supported to live their best lives, and when they 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

Clinical Reviewer, Physical Therapy

As a Clinical Reviewer, Physical Therapy you will be a key member of the utilization management team. We offer a meaningful way to make a difference in patients’ lives in a non-clinical environment. You can enjoy better work-life balance on a team that values collaboration and continuous learning while providing better health outcomes.

Collaboration Opportunities

• Functions in a clinical review capacity to evaluate all cases that do not pass the authorization approval process at first call, while promoting a collaborative approach with call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process.

Responsibilities

• Reviews charts and analyzes clinical record documentation to approve services that meet clinical review criteria.
• Monitors established quality of care standards in the participating provider network and for other clinical staff.
• Conducts regular audits to ensure guidelines are applied appropriately.
• In states where required, refers cases that cannot be approved to the Physician Clinical Reviewer. In states where allowed, makes denial determinations as warranted.
• Interacts with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials with clinical rationale.
• Provides excellent customer service through professional and accurate communication while maintaining NCQA and health plan timeframes.
• Documents all communication with medical office staff and treating providers.
• Adheres to utilization management policies and procedures in daily practice.
• Participates in ongoing training programs to ensure quality performance in compliance with applicable standards and regulations.

The Experience You’ll Need

• Current, unrestricted state licensure as a Physical Therapist.
• A physical therapist must hold a state license in physical therapy, hold a physical therapy degree from an accredited education program, and pass the national certification examination.
• 5+ years clinical experience preferred.
• Strong interpersonal and communication skills.
• Strong clinical, communication, and organizational skills.
• Energetic and curious with a passion for quality and value in health care.
• Computer proficiency.
• Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and not identified as an “excluded person” by the Office of Inspector General, or reprimanded or sanctioned by Medicare.
• No history of disciplinary or legal action by a state medical board.

Hiring Process and Compliance

To ensure a secure hiring process we have implemented identity verification steps, including submission of a government-issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.

Technical Requirements

We require that all employees have the following technical capability at their home: high-speed internet over 10 Mbps and, specifically for all call center employees, the ability to connect directly to the home internet router. These at-home technical requirements are subject to change with any scheduled reopening of our office locations.

Equal Opportunity

Evolent is an equal opportunity employer and considers all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

If you need reasonable accommodation to access the information provided on this website, please contact [e-mail] for further assistance.

Compensation and Benefits

The expected base salary/wage range for this position is $38-$40/hr. This position is eligible for a bonus component based on pre-defined performance factors. As part of our total compensation package, Evolent offers comprehensive benefits (including health insurance) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and may vary above or below the stated amounts.

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