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Speech Therapist or Physical Therapist or Occupational Therapist

Austin, Texas, United States
December 14, 2016

"* There will not be direct patient care involved.

Conducts pre-service, concurrent/continued stay, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

Service requests may be from electronic transmission, inbound calls and facsimile.

Outbound calls to the provider may be required to gather additional information that may be needed.

Conducts review activities which require the review of clinical information against client specific criteria, but excludes denial determinations.

Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract.

Consults with clinical reviewers and/or medical directors regarding members diagnosis, strengths and deficits, current functioning at home, at work and in the community to ensure medically appropriate, high quality, cost

effective care throughout the medical management process.

Collaborates with providers to assess members, needs for early identification of and proactive planning for therapy.