Reviewer - Therapy Services
Core
Review medical records to determine medical necessity and appropriate filing for therapy services (physical, occupational, and speech-language pathology) requests.
Role type
Licensed/Certified Allied Health Professional (Therapy Reviewer)
Builds
Authorization decisions for patient care
Domain
Healthcare / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical record review, Clinical guidelines interpretation, Regulatory compliance, Data analysis, Report writing, Clinical consultation
Preferred skills
Utilization Management, Skilled Nursing, Prior Authorization, Medicare Advantage Review
Technologies
Electronic health records systems, Authorization platforms
Responsibilities
Process system-generated authorization requests, Document findings and submit reports, Research and obtain additional clinical data, Act as a resource for internal and external customers, Maintain quality and productivity standards
Seniority
Individual Contributor, Non-Management