Reviewer-Therapy Services

Elevance Health; Norfolk (VA); Remote; USD 10,000 - 60,000; Full time

Job summary

Elevance Health is seeking a Reviewer – Therapy Services to evaluate therapy service requests while adhering to guidelines and regulations. This position allows virtual work full-time with occasional in-person training, focusing on optimizing health resources while ensuring compliance and satisfaction for patients. The ideal candidate will have strong communication and analytical skills, along with appropriate licensing in their field.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Equity stock purchase program

Qualifications

• Requires clinical experience in relevant therapy discipline.
• Certification and/or licensure appropriate to field of specialty required.
• Experience in healthcare environments beneficial.

Responsibilities

• Review medical records for approval of therapy services.
• Process authorization requests meeting contract requirements.
• Document findings and maintain standards of quality and productivity.

Skills

Communication

Problem-solving

Analytical skills

Education

Graduate of a college level program in physical therapy, occupational therapy, or speech language pathology

Active license as PTA, COTA, or SLP Assistant

Tools

Microsoft Office

Job description

Work schedule: M-F 8am to 5pm depending on your time zone.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, is the leader in health resource optimization, focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve.

The Reviewer – Therapy Services is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) were medically necessary and filed appropriately.

How you will make an impact:

Follows the system guidelines that makes decisions on approval for care for a patient.

Processes system generated decisions for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction.

Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements.

Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary.

Acts as a resource for internal and external customers.

May participate in intradepartmental teams, projects, and initiatives.

Maintains quality and productivity standards and ensures reviews are conducted within required timeframes.

Requires graduate of a college level program in physical therapy, occupational therapy, or speech language pathology or an accredited two-year program for a Physical Therapist Assistant, Occupational Therapist Assistant, or Speech Language Pathologist Assistant and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state required.

Certification and/or licensure appropriate to field of specialty is required.

Preferred Capabilities, Skills, and Experiences:

Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Knowledge in Microsoft Office.

For candidates working in person or remotely in the below location(s), the hourly* range for this specific position is $32.63 to $48.94.

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level:

Non-Management Non-Exempt

Anticipated End Date:

2025-06-18

Position Title:

Reviewer-Therapy Services

Job Description:

Reviewer - Therapy Services

Work schedule: M-F 8am to 5pm depending on your time zone.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, is the leader in health resource optimization, focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve.

The Reviewer – Therapy Services is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) were medically necessary and filed appropriately.

How you will make an impact:

• Follows the system guidelines that makes decisions on approval for care for a patient.

• Processes system generated decisions for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction.

• Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements.

• Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary.

• Acts as a resource for internal and external customers.

• May participate in intradepartmental teams, projects, and initiatives.

• Maintains quality and productivity standards and ensures reviews are conducted within required timeframes.

Minimum Requirements:

• Requires graduate of a college level program in physical therapy, occupational therapy, or speech language pathology or an accredited two-year program for a Physical Therapist Assistant, Occupational Therapist Assistant, or Speech Language Pathologist Assistant and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background.

• Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state required.

• Certification and/or licensure appropriate to field of specialty is required.

Preferred Capabilities, Skills, and Experiences:

• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

• Knowledge in Microsoft Office.

For candidates working in person or remotely in the below location(s), the hourly* range for this specific position is $32.63 to $48.94.

Locations: Colorado; Minnesota; Illinois

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

MED > Licensed/Certified Allied Health Professional

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [e-mail] for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

About the company

Elevance Health, Inc. is an American health insurance provider.

Notice

Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at [e-mail] or 407-000-0000.

Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.

An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report . NYC applicants may request an alternative process or accommodation at [e-mail] or 407-000-0000.