Utilization Specialty Therapist
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.
OT, PT, SLP Candidates must reside in the state of Texas
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.
• Perform detailed review of therapy service requests based on evidenced 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 organization to support provider relations and operations.
• Performs other duties as assigned
• Complies with all policies and standards
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. Adult and/or Pediatric clinical experience preferred.
Licenses/Certifications: Current state license in Physical Therapy, Occupational Therapy or Speech-Language Therapy. Speech-Language Therapist must have an active Certificate of Clinical Competence from the American Speech-Language-Hearing Association.
Preferred Experience:
• 6+ years of experience providing therapy services in healthcare or home health settings
• Adult and/or Pediatric clinical experience preferred
• Advanced clinical knowledge and ability to assess member needs in context of treatment plans and goals
• Review prior authorization therapy requests and review various stages of the review process
• Role requires adaptability and flexibility to business changes and new work processes
• Strong communication, strong attention to detail, organizational and time management skills
• Microsoft Office applications (Excel, Outlook, Word, OneNote) and the ability to use multiple avenues of digital communication (e.g. instant messaging, email, phone, video conferencing)
• Comfortable using digital video conferencing platforms (Zoom, MS Teams) is required.
Pay Range: $33.71 - $60.67 per hour
OT, PT, SLP Candidates must reside in the state of Texas
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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 regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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OT, PT, SLP Candidates must reside in the state of Texas
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.
• Perform detailed review of therapy service requests based on evidenced 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 organization to support provider relations and operations.
• Performs other duties as assigned
• Complies with all policies and standards
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. Adult and/or Pediatric clinical experience preferred.
Licenses/Certifications: Current state license in Physical Therapy, Occupational Therapy or Speech-Language Therapy. Speech-Language Therapist must have an active Certificate of Clinical Competence from the American Speech-Language-Hearing Association.
Preferred Experience:
• 6+ years of experience providing therapy services in healthcare or home health settings
• Adult and/or Pediatric clinical experience preferred
• Advanced clinical knowledge and ability to assess member needs in context of treatment plans and goals
• Review prior authorization therapy requests and review various stages of the review process
• Role requires adaptability and flexibility to business changes and new work processes
• Strong communication, strong attention to detail, organizational and time management skills
• Microsoft Office applications (Excel, Outlook, Word, OneNote) and the ability to use multiple avenues of digital communication (e.g. instant messaging, email, phone, video conferencing)
• Comfortable using digital video conferencing platforms (Zoom, MS Teams) is required.
Pay Range: $33.71 - $60.67 per hour
OT, PT, SLP Candidates must reside in the state of Texas
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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 regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Apply tot his job
Apply To this Job