ZipRecruiter

Log In

2

Remote Physical Therapy Utilization Review Jobs in Puerto Rico

OncoHealth

Case Review Representative

Guaynabo, PR · On-site +1

$13 - $15/hr

... physical, mental, and financial complexities of cancer through technology enabled services ... Remote/hybrid work experience preferred * A minimum of 2 years of healthcare related administrative ...

OncoHealth

Case Review Specialist - PR

Guaynabo, PR · On-site +1

... physical, mental, and financial complexities of cancer through technology enabled services ... Remote/hybrid experience preferred * A minimum of 2-4 years' administrative experience and/or ...

LifeLink

Remote Administrator on Call PR

Guaynabo, PR · On-site +1

Works closely with the Referral Coordinator (RC) in the utilization of available staff and ... Engages in review, education, and required organizational meetings to promote best practice sharing ...

Veterans Health Administration

$89K - $116K/yr

Observes the utilization of recreation therapy treatment modalities to ensure the most beneficial ... Must pass pre-employment physical examination. * Participation in the seasonal influenza ...

Veterans Health Administration

$89K - $116K/yr

Observes the utilization of recreation therapy treatment modalities to ensure the most beneficial ... Must pass pre-employment physical examination. * Participation in the seasonal influenza ...

Danaher

Field Application Specialist

Caguas, PR · On-site +1

... get life-saving therapies to patients faster; reclaiming time by automating tedious manual ... We recognize the benefits of flexible, remote working arrangements for eligible roles and are ...

US Department of Commerce

Meteorologist

Carolina, PR · On-site +1

$40K/yr

For consideration during the current review cycle, applications must be received by 11:59 p.m ... in physical meteorology * 2 semester hours in remote sensing of the atmosphere and/or ...

Bristol Myers Squibb

From optimizing a production line to the latest breakthroughs in cell therapy, this is work that ... Advise on applicable transfer mechanisms and review/negotiate DPAs, vendor contracts, and data ...

Veterans Health Administration

$119K - $154K/yr

... after review of the EDRP application. Former EDRP participants ineligible to apply. Learn more ... Must pass pre-employment physical examination. * Participation in the seasonal influenza ...

All JobsPhysical Therapy Utilization Review JobsRemote Physical Therapy Utilization Review JobsRemote Physical Therapy Utilization Review Jobs in Puerto Rico

Remote Physical Therapy Utilization Review information

What is a remote physical therapy utilization review?

A Remote Physical Therapy Utilization Review job involves evaluating physical therapy treatment plans and medical records to ensure they meet insurance guidelines and medical necessity. Professionals in this role work remotely to review claims, provide recommendations, and collaborate with healthcare providers and insurance companies. The goal is to ensure appropriate care while preventing unnecessary treatments or costs. This position typically requires a background in physical therapy, strong analytical skills, and knowledge of insurance policies and medical guidelines.

What does a typical day look like for someone in a remote physical therapy utilization review role?

A typical day involves reviewing physical therapy documentation and treatment plans submitted by providers to determine if they meet established medical necessity criteria. You may spend most of your workday analyzing patient records, applying evidence-based guidelines, documenting your recommendations, and collaborating virtually with providers, insurance representatives, and your clinical review team. Frequent video meetings and written communications are common as you clarify treatment justifications or support appeals. The role is fast-paced and detail-oriented, requiring strong organizational skills to manage multiple case files and deadlines efficiently. While remote, you remain an integral part of a clinical decision-making team, contributing directly to patient care quality and cost-effective service delivery.

What are the key skills and qualifications needed to thrive in the remote physical therapy utilization review position?

To excel as a Remote Physical Therapy Utilization Review professional, you need a background in physical therapy (often with licensure), clinical knowledge, and experience in utilization management or case review. Familiarity with electronic health records (EHR), claims management systems, and industry tools such as InterQual or Milliman criteria is typically required. Strong analytical skills, attention to detail, effective written communication, and the ability to work independently are valuable soft skills for this position. These abilities are crucial for accurately evaluating medical necessity, facilitating reimbursement, and ensuring compliance with healthcare guidelines in a remote setting.

What are popular job titles related to Remote Physical Therapy Utilization Review jobs in Puerto Rico?

For Remote Physical Therapy Utilization Review jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Remote Physical Therapy Utilization Review jobs in Puerto Rico look for?

The top searched job categories for Remote Physical Therapy Utilization Review jobs in Puerto Rico are:

What cities in Puerto Rico are hiring for Remote Physical Therapy Utilization Review jobs?

Cities in Puerto Rico with the most Remote Physical Therapy Utilization Review job openings:

Remote Physical Therapy Utilization Review jobs near you

Case Review Representative

OncoHealth

Guaynabo, PR • On-site, Remote

$13 - $15/hr

Full-time

Re-posted 9 days ago

Job description

About OncoHealth
OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, and patients navigate the physical, mental, and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto Rico, OncoHealth offers digital solutions for treatment review and virtual care across all cancer types.
About the Role
The Case Review Representative serves as a one-stop shop and intake of all calls (members and providers). Resolves tier one issues (user resets, provider data management, fax and letter receipt, general questions).
Primary Responsibilities
  • Flexible to work rotational shifts inside our office hours from 8:00 a.m. – 8:00 p.m. EST to cover the operational needs of the company. Shifts can range anywhere between Monday – Friday 8:00 am to 8:00 pm EST and Saturdays 8:30 am - 5:00 pm EST (Office hours may change/extend upon operational needs)
  • Fax intake and labeling
  • Prior authorization creation
  • Quality Performance Program Outreach when assigned
  • Triage and manage inbound calls, routing case specific calls to an appropriate team member, and resolving tier 1 level issues
  • Triage and manage inbound emails from health plan clients, routing case specific emails to an appropriate team member, and resolving tier 1 level issues
  • Triage request/claims processing issues to health plans as needed Prior authorization creation
  • Quality Performance Program Outreach when assigned
About You
  • College degree or relevant experience preferred
  • Fully Bilingual (English and Spanish)
  • Remote/hybrid work experience preferred
  • A minimum of 2 years of healthcare related administrative experience and/or customer service or relevant educational attainment required
  • Skills for implementation of systems for program effectiveness and productivity required
  • Systems/Tools: MS Office Suite proficient
About the Location
OncoHealth is committed to remote, hybrid or in office work options. Our Team in Puerto Rico reports to the office at least 2 times per month (advance notice provided/mandatory requirement) and can work remotely from home the rest of the days. Employees are welcome to work from the office every day if wanted.

Our Culture

Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – all with a focused mission of putting patients first!

We offer a full benefit package on your first day, along with a company bonus. You may visit or work from our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together!
OncoHealth is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and team members without regard to race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. All employment decisions are based on qualifications, merit, and business need.

The Opportunity

The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth has enjoyed rapid growth over the past 3 years and seeks smart, collaborative people to join its team. We have just under 250 team members, so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners amp; McKesson Corporation, we remain in an investment and growth mode. This means we are open-minded to how we get the work done – now is the perfect time to talk to us!

Our Current Solutions

Through the use of OncoHealth's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for all oncology drug request and treatments. Our system improves quality of care, reduces provider abrasion and gives health plans visibility into the total cost of oncology treatment.

OncoHealth offers Oncology Insights Pro, an analytic software solution that enables health plans to use data and analytics to improve oncology programs. Using real world data, our engineers normalize data to create analytic dashboards with drill down compatibilities. The data is the paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape.

OncoHealth offers Pharmacy Consulting services to health plans and pharmaceutical companies. New cancer treatments are entering the market at an unrelenting pace. Since 2018, the FDA approved 121 new cancer applications including 49 novel cancer drug entities. Our Board-Certified Oncology Pharmacologists can help health plans update drug policies, offer utilization management and formulary advice, and development training for staff.

OncoHealth's latest offering is Iris, a digital telehealth platform that delivers personalized, oncology-specific support to navigate the physical symptoms and emotional challenges caused by cancer and cancer treatment. Powered by technology, staffed 24X7, and delivered with empathy, Iris allows patients to connect with trained oncology experts and receive personalized, oncology-specific telehealth support.

Apply