Physical Therapy Utilization Review Specialist

Blue Cross Blue Shield of Massachusetts; Hingham (MA); Hybrid; USD 58,107 - 71,029; Full time

Benefits offered by this job

Paid time off

Medical/dental/vision insurance

401(k)

Wellness benefits

Job summary

A healthcare organization is looking for a Physical Therapy Utilization Management Reviewer in Hingham to evaluate outpatient rehabilitation services. The role involves conducting various reviews, collaborating with a dedicated team of healthcare professionals, and ensuring services align with clinical guidelines. Candidates should have relevant experience, a Doctor of Physical Therapy degree, and active licensure in Massachusetts. The position supports work-life balance with hybrid work options.

Qualifications

• 3-5 years relevant experience in various clinical health care settings.
• Utilization Management experience preferred.
• Active licensure in Massachusetts required.

Responsibilities

• Conduct pre-certification, concurrent and retrospective reviews.
• Evaluate members’ clinical status and develop cost-effective plans.
• Interact with treating providers to gather clinical information.

Skills

Critical thinking

Clinical judgment

Ability to communicate effectively

Ability to manage ambiguity

Proficient with multiple IT systems

Education

Doctor of Physical Therapy (DPT)

Master’s in Physical Therapy (MSPT)

Bachelor’s in Physical Therapy (BSPT)

Job description

A healthcare organization is looking for a Physical Therapy Utilization Management Reviewer in Hingham to evaluate outpatient rehabilitation services. The role involves conducting various reviews, collaborating with a dedicated team of healthcare professionals, and ensuring services align with clinical guidelines. Candidates should have relevant experience, a Doctor of Physical Therapy degree, and active licensure in Massachusetts. The position supports work-life balance with hybrid work options.