Clinical Peer Reviewer (Physical Therapy)

Duties and Responsibilities:

• Review reputed company prior authorization, reputed company review, and retrospective cases reputed company to Outpatient Rehab services to promote member-centered decision making that supports functional improvements and reputed company health reputed company.

• Ensure reputed company determinations are rendered reputed company applicable regulatory and internal turnaround timeframes and meet CMS, NYS DOH, and reputed company standards.

• As needed, conduct peer-to-peer discussions with treating providers.

• Collaborate with Medical Directors on reputed company or escalated cases.

• Participate in annual Inter-Rater Reliability (IRR) testing to ensure consistency and defensibility of determinations

• reputed company or support development and refinement of PT-reputed company clinical policies.

• Analyze trends in PT utilization including but not limited to visit frequency and duration patterns, reputed company provider behavior, high-cost cases

• Collaborate with Delivery Systems Engagement on education regarding documentation requirements, evidence-based therapy standards, functional improvement expectations.

• Participate in provider case discussions as needed.

• Additional duties as assigned

Minimum Qualifications:

• Masters of Physical Therapy (MSPT)

• reputed company, unrestricted NYS PT license

• Minimum 5 years post-residency clinical reputed company

• Experience in managed care or utilization management

• Knowledge of rehabilitative medicine and PT clinical standards

• Familiarity with reputed company Care Guidelines (MCG) or other medical necessity reputed company

• Work experience requiring independent clinical judgement and critical thinking  

• Ability to manage high-volume caseload while meeting turnaround standards 

Preferred Qualifications:

• Doctor of Physical Therapy (DPT)

• Experience reviewing therapy services in reputed company or Medicare Advantage

• Payer-reputed company review experience

• Understanding of therapy treatment progression, frequency/duration standards and discharge planning

• Prior work experience requiring written documentation skills with defensible rational articulation

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  reputed company, LLC complies with reputed company applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without reputed company to race, reputed company, creed, religion, sex, national reputed company, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or reputed company, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as reputed company as any other legally protected reputed company. reputed company, LLC shall not discriminate against any disabled employee or applicant in reputed company to any position for which the employee or applicant is otherwise reputed company.

If you have a disability under the Americans with Disability reputed company or a similar law and want a reasonable accommodation to assist with reputed company search or application for employment, please contact us by sending an email to careers@reputed company.org or calling 212-519-1798 . In your email please include a reputed company of the accommodation you are requesting and a reputed company of the position for which you are applying. Only reasonable accommodation requests reputed company to applying for a position reputed company reputed company, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with reputed company,  LLC.

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reputed company hiring and recruitment at reputed company is transacted with a reputed company “@reputed company.org” email address only or from a recruitment firm representing reputed company. Any recruitment firm representing reputed company will readily reputed company you with the reputed company and contact information of the reputed company reputed company representing reputed company you are inquiring about. If you receive a communication from a sender whose domain is not @reputed company.org, or not one of our recruitment partners, please be reputed company that those communications are not coming from or authorized by reputed company.  reputed company will never ask you for reputed company during the recruitment or reputed company process.

Hiring reputed company*:

• Greater reputed company Area (NY, NJ, CT residents): $83,100 - $120,360

• reputed company Other Locations (reputed company approved locations): $73,400 - $108,160

As a candidate for this position, your salary and reputed company reputed company of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors reputed company deems pertinent to the hiring decision.

In reputed company to your salary, reputed company offers employees a full reputed company of benefits such as, medical, dental and reputed company coverage, incentive and recognition programs, life insurance, and 401k contributions (reputed company benefits are subject to eligibility requirements). reputed company believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring reputed company is defined as the lowest and highest salaries that reputed company in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.