Description
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 developing clinical trainings, consultations, and guidance related to therapy authorizations and provisions
- Partners with leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies
- Provides feedback to leadership on opportunities to improve the review and therapy services and/or durable medical equipment outcomes to members based on standards and organizational policies
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires a Bachelor's degree and 4 – 6 years of related experience.
Advanced clinical knowledge of clinical therapy services and/or durable medical equipment preferred.
Strong knowledge of therapy regulations and guidelines preferred.
Strong knowledge of utilization management processes preferred.
License/Certification:
- PT - Physical Therapist required or
- OT - Occupational Therapist – Registered required or
- ST - Speech Therapist required
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
