Job Information
Anthem, Inc. Therapist Reviewer in Modesto, California
Description
SHIFT: Day Job
SCHEDULE: Full-time
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 Speech 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)
Applicable to Colorado Applicants Only
Hourly Pay Range*: $27.53/hr - $34.42/hr
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Must reside in one of the following states: California, Nevada, Oregon, Washington, Montana, Idaho, Wyoming, Utah, Colorado, Arizona and New Mexico
Hours: Monday through Friday 9:30am - 6pm PST
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
Qualifications
Qualifications:
Physical, and Speech Therapists, with a current, valid unrestricted license in the State of California, Nevada, Oregon or Washington with a license can be considered:
Clinical experience in an outpatient clinic or hospital setting is preferred
Clinical Experience with Pediatrics Developmental Delay preferred
Comfortable with muti-disciplinary review of PT, OT, ST cases preferred
Candidate with Orthopedic or Neurosurgical Spine experience (hospital, office or outpatient) is preferred
Candidate should have good computer skills and solid typing speed and accuracy
Familiarity with managed health care programs including HMO, PPO, and POS
Familiarity with Utilization Management Guidelines preferred
Familiarity with ICD-10 preferred
Previous utilization and/or quality management and/or call center experience helpful
Previous prior authorization experience preferred
The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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. An Equal Opportunity Employer/Disability/Veteran.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.
REQNUMBER: PS45083-California