Remote PT/OT Clinical Reviewer - Workers' Comp

Comagine Health; Sacramento (CA); On-site; USD 85,000 - 110,000; 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

Annual workspace stipend

100% remote work

Job summary

Comagine Health is seeking remote Clinical Reviewers (Licensed Physical Therapist or Occupational Therapist) to support workers' compensation therapy reviews. This is a full-time opening with an additional PRN/part-time role requiring two 4-hour shifts weekly.

Reviewers analyze medical records for medical necessity, apply guidelines, and document decisions with supporting rationale. Responsibilities include preparing review reports, coordinating with physician advisors, and handling pended cases

Qualifications

• Master's degree in PT or OT required
• Current unrestricted PT/OT license as required by applicable state contracts
• 5 years of direct clinical experience (patient care) or ICU/ER experience

Responsibilities

• Review clinical documentation to determine medical necessity and appropriateness of health care services.
• Perform prior authorization, concurrent and retrospective reviews using specified clinical criteria.
• Document review decisions and rationale.
• Collaborate with physicians, providers, clients, and internal teams to support accurate decisions.
• Create and draft denial summaries and recommendations.
• Validate CPT coding and amend reports after physician consultations.
• Communicate with clinics and coordinate with review teams to ensure timeliness and quality.

Skills

Clinical review

Medical records analysis

Research treatment guidelines

Communication

Documentation

Education

Master's Degree in Physical Therapy or Occupational Therapy

Tools

InterQual

ASAM

Milliman Criteria

Job description

Comagine Health is seeking remote Clinical Reviewers (Licensed Physical Therapist or Occupational Therapist) to support workers' compensation therapy reviews. This is a full-time opening with an additional PRN/part-time role requiring two 4-hour shifts weekly.

Reviewers analyze medical records for medical necessity, apply guidelines, and document decisions with supporting rationale. Responsibilities include preparing review reports, coordinating with physician advisors, and handling pended cases