Utilization Mgmt PTOT Thr Spc at Texas Children's Medical Center

DescriptionWere looking for a Utilization Management Physical a Therapy Specialist someone whos ready to grow with our this position you will provide prior authorization of outpatient and home physical and occupational therapy services requiring authorization. This process includes using clinical judgement for utilization management application of product benefits understanding of regulatory requirements and verification of medical necessity utilizing evidence-based addition provider education is a component of this process.Think youve got what it takesJob Duties & Responsibilities Assess the treatment plan clinical information and medical necessity of all requested services. Utilizes established criteria to appropriately certify requested services within established timeframe required. Consults with physicians and therapists regarding members history and current care needs on an ongoing basis. Refers cases failing to meet medical necessity criteria to the medical director or designee for review and disposition. Conducts timely entry of information into systems and assigns appropriate length of service per established guidelines and communicates authorization numbers to providers and members. Evaluates benefit coverage and regulatory guidelines pertinent to decision making. Facilitates provider communication and education. Liaisons with internal and external managed care staff members. Assess and refer to potential case management cases. Ongoing assessment for quality indicators and concerns.Skills & Requirements Required Degree in Physical Therapy Preferred Masters degree Physical Therapy Required PT - Physical Therapist by the Texas Board of Physical Therapy Examiners 5 years required in Professional physical therapy and/or utilization management experience Key Skills Aeronautical,Client Servicing,Council,Art And Craft,Hydraulics,Jboss Employment Type : Full-Time Experience: years Vacancy: 1