Senior Clinical Review Therapist - Physical Health

Position Purpose: Performs complex 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. Applies clinical knowledge and provides recommendations to senior management team to identify ways to improve the review and execution of therapy services based on clinical reviews of service request. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Applicants for this role have the flexibility to work remotely within the continental United States. Schedule: The work schedule includes holiday coverage Assesses and performs utilization reviews of service requests regarding complex 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 Manages and collaborates works with Utilization and Care Management team and healthcare providers to ensure members are receiving the appropriate care and treatment Applies advanced clinical therapy specialty knowledge and identifies areas of concern and improvement with therapy services and/or durable medical equipment for members Provides education including de