Utilization Specialty OT Therapist Pediatric

RemoteWorker CA; League City (TX); Remote; USD 10,000 - 60,000; Full time

Job summary

Join a dynamic team that impacts the lives of 28 million members as a clinical professional in Medical Management. This role focuses on performing utilization reviews for specialty therapy services, ensuring adherence to evidence-based practices, and providing clinical recommendations. With a commitment to workplace flexibility, this innovative organization offers a comprehensive benefits package, including competitive pay, health insurance, and opportunities for professional growth. If you have a passion for therapy and a desire to support providers and patients alike, this is the perfect opportunity for you to make a difference in the healthcare landscape.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Holidays

Flexible Work Schedules

Qualifications

• 3+ years of experience providing therapy services in healthcare or home health settings.
• Current state license in Occupational Therapy required.

Responsibilities

• Perform utilization review of authorization requests for specialty therapy services.
• Provide clinical expertise and support to therapy providers.

Skills

Utilization Review

Clinical Recommendations

Evidence-Based Practice

Home Health Experience

Pediatric Clinical Experience

Education

Master’s Degree in Specialty Therapy

Equivalent Experience

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Perform utilization review of authorization requests regarding specialty therapy services for members, including speech language, occupational, and physical therapy across the identified regions and products. Assist with training and network management support for therapy providers.

We are looking for someone who has Home Health/Outpatient experience.

• Perform detailed review of therapy service requests based on evidence-based practice, documentation standards as indicated by the national therapy associations, and organizational policies.
• Refer members to case management as appropriate based on service request assessment.
• Provide clinical recommendations for any adverse therapy determination.
• Provide clinical expertise based on shared practice standards regarding sub-specialty therapy practice to peers.
• Provide support for specialty therapy providers, including assistance with clinical trainings, consultation, and guidance on matters related to therapy authorization and provision.
• Provide clinical expertise to multi-functional areas within the organization to support provider relations and operations.

Education/Experience: Master’s degree in area of specialty therapy or equivalent experience. 3+ years of experience providing therapy services in healthcare or home health settings. Pediatric clinical experience preferred.

Licenses/Certifications: Current state license in Occupational Therapy.

Pay Range: $33.03 - $59.47 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without