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Physical Therapist Reviewer-PRN

2 months ago

Selma, United States Acentra Health Full time

CNSI and Kepro are now Acentra Health Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra is looking for a Physical Therapist Reviewer (Remote) join our growing team.

Are you an experienced Physical Therapist looking for a new challenge?

  • Do you value care management and quality improvement?
  • Are you motivated, energetic, and excited to become part of the Acentra Health team?
If so, you might be our next new team member

Job Summary:

In this PRN position, the physical therapist will perform prior authorization reviews for the Alabama Utilization Management contract. The Physical Therapist will utilize clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness, while maintaining production goals and QA standards. This person will also ensure day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards.

This is a remote position, and PRN (as needed)

Job Responsibilities:
  • Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the medical record documentation supports the need for services.
  • Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.
  • Abstracts review related data/information accurately and timely on appropriate review tool by the appropriate means. Accurate and timely submission of all administrative and review related documents to appropriate parties.
  • Performs ongoing reassessment of review process to offer opportunities for improvement and/or change.
  • Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process.
  • Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.
  • Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.
  • Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following Acentra Health policies, procedures and guidelines.
  • Actively cross-trains to perform duties of other contracts within the Acentra Health network to provide a flexible workforce to meet client/consumer needs.
Required Qualifications
  • Active unrestricted Physical Therapy license with the Alabama Board of Physical Therapy and Board of Medical Examiners (if applicable).
  • Must reside in the state of Alabama
  • May not hold a concurrent working relationship with an Alabama Medicaid-enrolled provider while working on this contract.
  • Vast Knowledge of Medicaid wheelchair policy
  • Must not hold a concurrent working relationship with a Medicaid-enrolled provider.
  • Ability to work on a as needed basis (PRN)
  • Minimum two years of clinical experience in physical therapy/rehab environment required.
  • Must be proficient in Microsoft Office and internet/web navigation.
  • Medical record abstracting skills required.
  • Knowledge of the organization of medical records, medical terminology, and disease process required.
  • Strong clinical assessment and critical thinking skills required.
  • Excellent verbal and written communication skills required.
Preferred Experience
  • Previous utilization management experience preferred but not required.
  • Knowledge of current NCQA/URAC standards preferred.
Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is $42-$49 per hour

"Based on our compensation program, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Thank You

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE AA M/F/Vet/Disability

Acentra Health 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, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Requirements

Required Qualifications
  • Active unrestricted Physical Therapy license with the Alabama Board of Physical Therapy and Board of Medical Examiners (if applicable).
  • Must reside in the state of Alabama
  • May not hold a concurrent working relationship with an Alabama Medicaid-enrolled provider while working on this contract.
  • Vast Knowledge of Medicaid wheelchair policy
  • Must not hold a concurrent working relationship with a Medicaid-enrolled provider.
  • Ability to work on a as needed basis (PRN)
  • Minimum two years of clinical experience in physical therapy/rehab environment required.
  • Must be proficient in Microsoft Office and internet/web navigation.
  • Medical record abstracting skills required.
  • Knowledge of the organization of medical records, medical terminology, and disease process required.
  • Strong clinical assessment and critical thinking skills required.
  • Excellent verbal and written communication skills required.
Preferred Experience
  • Previous utilization management experience preferred but not required.
  • Knowledge of current NCQA/URAC standards preferred.

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