Therapy Services Reviewer

Elevance Health; Brentwood (TN); Remote; USD 55,000 - 75,000; Full time

Job summary

Elevance Health is seeking a Therapy Services Reviewer responsible for reviewing therapy service requests for medical necessity. The role involves documentation, analysis, and coordination with clinical reviewers. Candidates must be licensed therapists with clinical experience, focused on improving healthcare services and member outcomes.

Benefits

Paid Time Off

Medical benefits

401(k) with match

Incentive bonus programs

Wellness programs

Financial education resources

Qualifications

• Minimum of 1 year of clinical experience in relevant therapy fields.
• Requirements include specific licensure in applicable therapy domains.

Responsibilities

• Review medical records to determine therapy service necessity and appropriateness.
• Document findings and develop analyses for departmental reports.
• Process authorization requests while meeting contract and operational standards.

Skills

Analytical Skills

Detail-Oriented

Research

Documentation

Communication

Education

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

Unrestricted license as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant

Job description

The Therapy Services Reviewer 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.

Location: Remote

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.

Job Level:

Non-Management Non-Exempt

Anticipated End Date:

2025-05-30

Position Title:

Therapy Services Reviewer

Job Description:

The Therapy Services Reviewer 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.

Location: Remote

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.

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.

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