ZipRecruiter

Log In

2

Assistant Remote Occupational Therapy Utilization Review Jobs in Wisconsin

Network Health WI

Associate Medical Director

Menasha, WI · On-site +1

Job Responsibilities: * Assist the CMO with monitoring availability, appropriateness, and necessity ... of utilization review and quality assessment processes * Provide medical consultation as requested ...

Harris

Esrun Health is seeking Medical Assistants to work part-time from their home office as independent ... Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ...

Harris

Esrun Health is seeking Medical Assistants to work part-time from their home office as independent ... Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ...

Harris

Esrun Health is seeking Medical Assistants to work part-time from their home office as independent ... Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ...

Harris

Esrun Health is seeking Medical Assistants to work part-time from their home office as independent ... Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ...

Bcbsa

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

The Hiring Platform

Remote Reservations Coordinator

Madison, WI · Remote

$17.50 - $22.25/hr

Research availability based on client requests * Assist with reservation coordination * Review ... Fully remote environment * Onboarding and training * Continuing education * Access to professional ...

New

previous pagenext page

Showing results 21-40

All JobsOccupational Therapy Utilization Review JobsAssistant Remote Occupational Therapy Utilization Review JobsAssistant Remote Occupational Therapy Utilization Review Jobs in Wisconsin

Assistant Remote Occupational Therapy Utilization Review information

What is the difference between Assistant Remote Occupational Therapy Utilization Review vs Assistant Remote Physical Therapy Utilization Review?

AspectAssistant Remote Occupational Therapy Utilization ReviewAssistant Remote Physical Therapy Utilization Review
CertificationsOccupational Therapy Assistant (OTA) certificationPhysical Therapy Assistant (PTA) certification
Work EnvironmentRemote review of occupational therapy cases, healthcare settingsRemote review of physical therapy cases, healthcare settings
Employer & Industry UsageHospitals, clinics, insurance companiesHospitals, clinics, insurance companies
Common Search & ComparisonOften compared for similar roles in therapy utilization reviewRelated but focused on physical therapy cases

Both roles involve remote review of therapy cases, requiring relevant certifications and healthcare industry experience. The main difference lies in the therapy type—occupational versus physical therapy—each with specific certifications and case types. Understanding these distinctions helps job seekers identify the right role based on their credentials and interests.

What are popular job titles related to Assistant Remote Occupational Therapy Utilization Review jobs in Wisconsin?

For Assistant Remote Occupational Therapy Utilization Review jobs in Wisconsin, the most frequently searched job titles are:

What job categories do people searching Assistant Remote Occupational Therapy Utilization Review jobs in Wisconsin look for?

The top searched job categories for Assistant Remote Occupational Therapy Utilization Review jobs in Wisconsin are:

What cities in Wisconsin are hiring for Assistant Remote Occupational Therapy Utilization Review jobs?

Cities in Wisconsin with the most Assistant Remote Occupational Therapy Utilization Review job openings:

Assistant Remote Occupational Therapy Utilization Review jobs near you

Weekend Associate Medical Director - 0.3 FTE

Network Health, Inc

Brookfield, WI • On-site, Remote

Full-time

Re-posted 10 days ago

Network Health rating

7.9

Company rating: 7.9 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

186th of 311 rated insurance

Job description

In support of the CMO, the Associate Medical Director is responsible for the administration of procedures, protocols, and standards regarding the efficiency and quality of the health care delivered to Network Health (NH) members. This individual will be chair of at least 3 committees related to quality and accreditation.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel is required occasionally for the position.

Hours: 0.3 FTE, 24 hours per pay period, 8am - 5pm Friday through Sunday

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

  • Assist the CMO with monitoring availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers
  • Participate in oversight and clinical decision making of the UM program, including but not limited to rendering denial determinations for services not considered medically necessary or experimental/investigation/unproven in accordance with regulatory and quality standards
  • Contribute to the development of quality care guidelines, internal peer review procedures, and the evaluation of medical care evaluation studies under the NHP quality assurance programs. In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality assessment processes
  • Provide medical consultation as requested for:
    • Medical/legal issues
    • Member grievance procedures
    • Development and implementation of new benefit packages and the interpretation of covered benefits in NHP contracts
    • Medical issues related to contract negotiations with health care providers
    • Determining if services to members/enrollees meet medical criteria
  • Promote positive relationship between NHP and medical community
  • Serve as liaison between NHP and providers regarding matters of medical policy and medical administration
  • Serve as spokesperson for NHP in the medical community and maintains appropriate contact with professional health care organizations
  • Participates in the ongoing recruitment of plan physicians.
  • Respond to physicians and other provider inquiries and complaints within established guidelines of the Executive Committee and Board of Directors
  • Assist in the development of appropriate medical guidelines and parameters for claims review
  • Assist in the training of NHP staff on matters relating to medical guidelines
  • Oversight responsibility for monitoring and evaluating Medicare Special Needs Plan Model of Care effectiveness
  • Perform second level review of provider appeals and disputes
  • Serve on committees as coordinated with the CMO
  • Assist in strategic planning targeted towards plan growth initiatives

Job Requirements:

  • Doctor of Medicine (MD or DO), licensed in the state of Wisconsin without restriction

  • Member in good standing of the local medical community. An active practitioner of medicine in the NHP service areas

  • Must possess a thorough knowledge of the health professional and facilities and standards of practice of medicine in NHP’s service area

  • Must possess sufficient medical experience and other experience, including knowledge of the Medicare program, to review organization determinations involving medical necessity

  • Board certified in an ABMS medical specialty required

Network Health is an Equal Opportunity Employer

What Network Health employees say

Pay

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply