Remote PT/OT Clinical Reviewer - Workers' Comp Therapy

Comagine Health; Seattle (WA); On-site; USD 75,000 - 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

Job summary

Comagine Health is seeking remote Clinical Reviewers licensed as Physical Therapists or Occupational Therapists in Washington state to support workers' compensation therapy reviews. This full-time role involves evaluating medical records, applying clinical criteria, and preparing review reports and denial recommendations.

The position requires independent decision-making and strong communication with clients, providers, and internal teams.

Qualifications

• Masters Degree in Physical Therapy or Occupational Therapy and active licensure in Washington state
• 5 years of direct clinical experience or ICU/ER experience
• Ability to apply workers' compensation treatment guidelines and clinical criteria

Responsibilities

• Review clinical documentation to determine medical necessity and appropriateness of services
• Perform prior authorization, concurrent and retrospective reviews using clinical criteria
• Create denial summaries and recommendations with rationale
• Validate or correct CPT coding as needed
• Communicate with clinics, clients, and internal teams to facilitate timely decisions
• Draft reports and provide support for medical affairs reviews
• Maintain compliance with HIPAA/PHI and document review in the care management system
• Assist with non-clinical staff oversight and QA activities

Skills

Advanced critical thinking

Oral & written communication

MS Office proficiency

Organizational skills

Interpersonal skills

Problem-solving

Attention to detail

Multitasking in teams

Education

Masters Degree in Physical Therapy or Occupational Therapy

Tools

InterQual Criteria

Milliman Criteria

Electronic health records systems

Job description

Comagine Health is seeking remote Clinical Reviewers licensed as Physical Therapists or Occupational Therapists in Washington state to support workers' compensation therapy reviews. This full-time role involves evaluating medical records, applying clinical criteria, and preparing review reports and denial recommendations.

The position requires independent decision-making and strong communication with clients, providers, and internal teams.