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Physical Therapy Utilization Review Specialist

2 months ago

Pontiac, Michigan, United States TheraMatrix Full time
Job Summary

TheraMatrix is seeking a highly skilled Physical Therapy Utilization Review Specialist to join our team. As a key member of our healthcare team, you will be responsible for reviewing and authorizing outpatient physical therapy services to ensure they meet our defined plan guidelines.

Key Responsibilities
  • Initial Authorizations: Review and authorize services that meet criteria, along with supporting documentation, to ensure outpatient physical therapy services are provided at the appropriate level.
  • Re-authorization/Concurrent Review: Review clinic documentation submitted by the provider to ensure services continue to meet defined plan guidelines.
  • Care Management: Review all cases meeting criteria to determine if the member qualifies for TheraMatrix's internal Care Management program and facilitate all related communications.
Additional Responsibilities
  • Investigate and resolve questions related to authorization and claims activity.
  • Assist in maintaining department compliance with state, federal, and HIPAA regulations.
  • Assist in resolving issues relative to clinical procedures.
  • Participate in monthly Health Services Meetings.
  • Potential for limited local travel to attend Client Health Fairs.
Requirements
  • Two to five years of experience, preferably in a managed care environment.
  • Working knowledge of the physical therapy industry is a definite plus.
  • Strong written and verbal communication skills.
  • Strong customer service skills/experience.
  • Strong computer skills a must (Word, Excel, etc.).
  • Independent, self-starter who is results and goal oriented.
Education

A healthcare professional with an acquired background in physical therapy. Must possess an Associate's Degree, Bachelor's degree preferred. Experience in lieu of a degree will be considered.