Anthem, Inc. Therapist Reviewer Sr in Grand Prairie, Texas
SHIFT: Day Job
Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which we’re creating greater care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
Location: Houston or Dallas, Texas The person in this position must work in our Houston or Dallas location. Remote work will be considered after 90 days.
The Therapist Reviewer Senior (Physical or Occupational Therapist) is responsible for the review of medical records, including more complex cases, to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) are medically necessary and filed appropriately. Primary duties may include, but are not limited to:
Applies professional therapy, government regulation and medical policy knowledge to medical review, and makes determinations for authorization requests, meeting all contract requirements, processes and operational unit goals to ensure customer satisfaction.
Maintains knowledge of regulations and requirements through review of current regulations and/or policies.
Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements.
Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary.
Acts as a resource for internal and external customers.
Participates in or leads intradepartmental teams, projects and initiatives.
Maintains quality and productivity standards, and ensures reviews are conducted within required timeframes.
Graduate of a college level program in physical or occupational therapy, 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
At least 10 years experience is preferred.
Current active unrestricted license as a physical or occupational therapist in applicable state required.
Pediatric experience preferred.
Home Health Care experience preferred.
Microsoft Office knowledge.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran