Clinical Reviewer, Physical Therapy

Evolent; Raleigh (NC); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company in healthcare is seeking a Clinical Reviewer for Physical Therapy. This role focuses on evaluating clinical documentation and ensuring quality standards within the provider network. Join a mission-driven team that values diversity and inclusion while impacting patient lives in a non-clinical setting.

Benefits

Performance-based bonuses

Comprehensive benefits

Work/life balance

Flexibility

Autonomy

Qualifications

• Current, unrestricted state licensure as a Physical Therapist.
• Preferably 5+ years of clinical experience.

Responsibilities

• Evaluate cases that do not pass initial authorization.
• Review charts and analyze clinical documentation.
• Conduct audits to ensure proper guideline application.

Skills

Interpersonal Skills

Communication Skills

Organizational Skills

Clinical Skills

Education

Degree from an accredited program

Job description

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 fragmented healthcare systems and ensure equitable, compassionate care for all.

Our employees enjoy work/life balance, flexibility, and autonomy, fostering an environment where they can perform their best work while living fulfilling lives. Diversity and inclusion are integral to our culture.

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 vital part of the utilization management team. This role offers a meaningful way to impact patient lives in a non-clinical setting, with a focus on collaboration and continuous learning to improve health outcomes.

• Evaluate cases that do not pass initial authorization, supporting a team approach with call center staff. Initial reviews are supported by Physician clinical review staff (MDs).

What You Will Be Doing :

Review charts and analyze clinical documentation to approve services meeting review criteria.

Monitor quality standards within the provider network and for clinical staff.

Conduct audits to ensure proper guideline application.

Refer cases requiring physician review or make denial determinations where permitted by state law.

Communicate with medical staff to gather information, notify of decisions, and provide clinical rationale.

Maintain excellent customer service and document all communications.

Adhere to policies and participate in ongoing training to ensure compliance and quality.

The Experience You’ll Need :

• Current, unrestricted state licensure as a Physical Therapist.
• Degree from an accredited program and passing the national exam.
• Preferably 5+ years of clinical experience.
• Strong interpersonal, communication, organizational, and clinical skills.
• A passion for quality and value in healthcare.
• No exclusions or sanctions by health programs or legal actions against medical licensing boards.

Technical Requirements :

High-speed internet (>10 Mbps) and direct connection capability are required at home. These requirements may change with office reopenings.

Evolent is an equal opportunity employer, committed to diversity and inclusion. Reasonable accommodations are available upon request.

The base salary range for this position is $38-40 per hour, with eligibility for performance-based bonuses and comprehensive benefits.

If this role isn't the perfect fit, submit your contact info and resume to be considered for future opportunities.

Create a job alert for this search