Anthem, Inc. Therapist Reviewer in Fairfax, Virginia
SHIFT: Day Job
AIM Specialty Health (AIM), a proud member of the Anthem family of companies, is a national leader in specialty benefit management. Through an innovative technology platform and steadfast commitment to excellent customer service, AIM promotes the appropriate, safe and cost effective use of clinical services including: musculoskeletal, radiology, cardiology, oncology, specialty drugs, and sleep medicine.
If you have a Physical Therapist or Occupational Therapist License, we want to talk to you! If you are enthusiastic about making a difference in the lives of patients, pursuing a rewarding career, and enjoying more free time with family and friends to explore your interests outside of work - consider a career as a Therapist Reviewer.
Therapist Reviewer (Utilization Clinical Reviewer)
This position is W@H must be okay working PST or CST hours.
The position is Monday through Friday
Hours based on your time zone: 9:30am-6pm PST 10:30am-7pm MST 9:30am-6pm CST 10:30am-7pm EST
Therapist Reviewers are responsible for conducting pre-authorization, out of network and appropriateness of treatment reviews for musculoskeletal procedures and other services by utilizing appropriate policies, clinical and department guidelines. They collaborate with healthcare providers to promote the most appropriate, highest quality and effective use of physical, occupational, and speech therapy visits to ensure quality member outcomes, and to optimize member benefits. Primary duties may include, but are not limited to:
Receives pre-authorization requests from front-line intake
Conducts initial medical necessity clinical review
Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review
Conducts initial medical necessity review of out of network pre-authorization requests for services requested outside of the client health plan network
Notifies ordering physician or rendering service provider office of the pre-authorization determination decision
Documents the results of the initial clinical review and determination in the pre-certification computer system
Maintains confidentiality of patient and provider-specific information
Develops telephone service standards to meet departmental performance metrics
Graduate of a college level program in physical therapy, occupational therapy, and 4 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current active unrestricted license as a physical therapist or occupational therapist in applicable state required.
Licensure appropriate to field of specialty as required.
A combination of postgraduate pediatric developmental delay and outpatient orthopedic experience preferred
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs, and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.