Therapist Reviewer

Company: Anthem, Inc.
Location: Concord
Posted on: May 3, 2021

Job Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

AIM Specialty Health (AIM), a proud member of the Anthem family of companies, is a national leader in specialty benefit management. Through an innovative technology platform and steadfast commitment to excellent customer service, AIM promotes the appropriate, safe and cost effective use of clinical services including: musculoskeletal, radiology, cardiology, oncology, specialty drugs, and sleep medicine.

If you have a Physical Therapist or Speech Therapist License, we want to talk to you! If you are enthusiastic about making a difference in the lives of patients, pursuing a rewarding career, and enjoying more free time with family and friends to explore your interests outside of work - consider a career as a Therapist Reviewer.

Therapist Reviewer (Utilization Clinical Reviewer)

Must Reside in one of the following states: California, Nevada, Oregon, Washington, Montana, Idaho, Wyoming, Utah, Arizona and New Mexico

Hours: Monday through Friday 9:30am - 6pm PST

Therapist Reviewers are responsible for conducting pre-authorization, out of network and appropriateness of treatment reviews for musculoskeletal procedures and other services by utilizing appropriate policies, clinical and department guidelines. They collaborate with healthcare providers to promote the most appropriate, highest quality and effective use of physical, occupational, and speech therapy visits to ensure quality member outcomes, and to optimize member benefits. Primary duties may include, but are not limited to:

• Receives pre-authorization requests from front-line intake
• Conducts initial medical necessity clinical review
• Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review
• Conducts initial medical necessity review of out of network pre-authorization requests for services requested outside of the client health plan network
• Notifies ordering physician or rendering service provider office of the pre-authorization determination decision
• Documents the results of the initial clinical review and determination in the pre-certification computer system
• Maintains confidentiality of patient and provider specific information
• Develops telephone service standards to meet departmental performance metrics

Qualifications

Qualifications:

• Physical, and Speech Therapists, with a current, valid unrestricted license in the State of California, Nevada, Oregon or Washington with a license can be considered:
• Clinical experience in an outpatient clinic or hospital setting is preferred
• Clinical Experience with Pediatrics Developmental Delay preferred
• Comfortable with muti-disciplinary review of PT, OT, ST cases preferred
• Candidate with Orthopedic or Neurosurgical Spine experience (hospital, office or outpatient) is preferred
• Candidate should have good computer skills and solid typing speed and accuracy
• Familiarity with managed health care programs including HMO, PPO, and POS
• Familiarity with Utilization Management Guidelines preferred
• Familiarity with ICD-10 preferred
• Previous utilization and/or quality management and/or call center experience helpful
• Previous prior authorization experience preferred

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. An Equal Opportunity Employer/Disability/Veteran.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions

Keywords: Anthem, Inc., Concord , Therapist Reviewer, Other , Concord, California