Pt Utilization Review Jobs (NOW HIRING)

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.

NOTE: Texas - Statewide Candidates will be considered and required to have a current OT, PT, or CCC-SLP license issuedby the state of Texas

Work Schedule: Monday - Friday: 8 am - 5 pm (CST)

Position 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

Education/Experience: Requires a Bachelor's degree and minimum of 2 - 4 years of related specialty therapy experience (e.g. OT, PT, and SLP).

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.

NOTE: Texas - Statewide Candidates will be considered and required to have a current OT, PT, or CCC-SLP license issuedby 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