Clinical Review Therapist - Physical Health at Centene

Ideal for a licensed OT, PT, or CCC-SLP with at least two to four years of clinical experience. You must hold an active license issued by the state of Texas to

Work type: remote

Location: Remote-TX

Salary: $31 – $55/hr

Type: Full-time

Summary

Ideal for a licensed OT, PT, or CCC-SLP with at least two to four years of clinical experience. You must hold an active license issued by the state of Texas to qualify for this role. **What makes it worth a look...** Centene offers a pay range of $30.58 to $55.09 per hour for this fully remote position that is open to residents of other states. The benefits package includes a 401K plan, stock purchase options, and tuition reimbursement. **You might be a good fit if you...** * Hold an active Texas-issued license for OT, PT, or CCC-SLP. * Have experience with utilization management or clinical therapy reviews. * Possess technical proficiency in Microsoft Office, specifically Excel, OneNote, and Co-Pilot. * Are comfortable navigating digital video conferencing platforms like Zoom and MS Teams.

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.
 

Work Schedule: Monday – Friday: 9 am – 6 pm (CST) with a flexible/rotating weekend shift, either Saturday or Sunday.NOTE: Candidates may reside in another state, but must have a current OT, PT, or CCC-SLP license issued by the state of TexasPosition Purpose: Performs clinical reviews of clinical therapy services and/or durable medical equipment to members based on service request assessments and provides clinical expertise based on practice standards. Works with senior management to identify ways to improve the review and execution of therapy services based on clinical reviews of service request assessments.

• Performs utilization reviews of service requests regarding specialty therapy services and/or durable medical equipment for members based on best practice and documentation standards by the national therapy associations and organizational policies


• Provides recommendations for therapy determinations and refers members to care management, as appropriate, based on service request assessments


• Works with Utilization and Care Management teams and healthcare providers to ensure members are receiving the appropriate care and treatment


• Expands therapy specialty knowledge and works with senior management to identify areas of improvement with therapy services and/or durable medical equipment for members


• Assists with providing education including developing clinical trainings, consultations, and guidance related to therapy authorizations and/or durable medical equipment


• Provides feedback to leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies


• Performs other duties as assigned


• Complies with all policies and standards

Preferred Education/Experience:

• Master’s degree in area of specialty therapy and 5+ years of experience providing therapy services in-patient, outpatient, home health, and/or managed care settings preferred.


• Clinical knowledge of clinical therapy services, durable medical equipment, and assisted therapy devices preferred.


• Experience with Adult and Pediatric Therapy preferred


• Advanced clinical knowledge and ability to assess member needs in context of treatment and therapy authorizations


• Knowledge of therapy regulations and guidelines preferred


• Knowledge of utilization management processes preferred


• Role requires adaptability and flexibility to business changes, distribution of work, training, and technology processes


• Strong communication, strong attention to detail, organizational and time management skills


• Microsoft Office applications (Co-Pilot, 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)

Licenses/Certifications:Required

• OT–Occupational Therapist- Registered required or


• PT - Physical Therapist required or


• CCC-SLP - Speech-Language Therapist required and must have an active Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association.

Pay Range: $30.58 - $55.09 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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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