Remote Clinical Review Specialist - PT/OT (W/C)

Comagine Health; Anchorage (AK); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Paid time off

Retirement savings plan with employer

Adoption financial assistance

Paid parental leave

Job summary

Comagine Health is seeking remote Clinical Reviewers (Licensed Physical Therapist or Occupational Therapist) to support workers' compensation therapy reviews. This full-time role evaluates therapy authorization requests and medical records to determine medical necessity and appropriateness using clinical criteria and organizational policies.

Collaborate with physician advisors, providers, clients, and internal teams to document decisions, prepare review reports, and advise on denials when

Qualifications

• Masters Degree in Physical Therapy or Occupational Therapy.
• Current, active, unrestricted Physical Therapist or Occupational Therapist licensure in Washington state as required by applicable state contract.
• 5 years of clinical (direct patient care) experience or ICU and/or ER experience.

Responsibilities

• Review clinical documentation to determine medical necessity and appropriateness of health care services.
• Perform prior authorization, concurrent and retrospective reviews applying specified clinical review criteria.
• Conduct level of care reviews and other reviews as needed.
• Document review decisions and draft denial summaries and recommendations.
• Validate CPT coding and draft amended reports after physician-to-physician consultations.
• Communicate with clients, providers, and internal teams to provide relevant information.

Skills

Clinical review

Communication

Collaboration

Research

Documentation

Education

Masters in PT/OT

Tools

InterQual

ASAM

Milliman Criteria

EHR systems

Job description

Comagine Health is seeking remote Clinical Reviewers (Licensed Physical Therapist or Occupational Therapist) to support workers' compensation therapy reviews. This full-time role evaluates therapy authorization requests and medical records to determine medical necessity and appropriateness using clinical criteria and organizational policies.

Collaborate with physician advisors, providers, clients, and internal teams to document decisions, prepare review reports, and advise on denials when