Job Title: Physical Therapist (PT) - Utilization Management

Organization: Managed Care Organization

Position Overview: The Managed Care Organization is seeking a qualified Physical Therapist (PT) to join our Utilization Management Team. This position will primarily involve conducting chart reviews to determine the medical necessity of physical and occupational therapy authorization requests. Additionally, the role includes process and performance improvement consulting, encompassing training, auditing, calibration sessions, and peer-to-peer support/coaching.

Key Responsibilities:

1. Chart Review and Evaluation: Assist the Utilization Management Team (Nurses and Medical Directors) in evaluating the medical necessity of select physical and occupational therapy services.

2. Recommendation Provision: Provide informed recommendations to the Health Plan based on comprehensive chart reviews and clinical expertise.

3. Process Improvement Consulting: Collaborate in process and performance improvement initiatives, including training, auditing, calibration sessions, and peer-to-peer support/coaching.

Must-Have Skills:

1. Prior experience in chart review and application of clinical criteria.
2. Previous experience with maintenance therapy services for children with chronic health conditions.
3. Familiarity with Kentucky Medicaid Therapy Regulations.

Requirements:

• Years of Experience: Minimum of 3 years in a relevant clinical setting.
• Licensure / Education: Unrestricted Licensed Therapist 

Desired Start Date: To be determined. Duration of Assignment: To be determined. Hours per Week: No more than 4 hours per day (hours will vary depending on volume/needs). Estimated OT Hours per Week (if applicable): None.

Additional Information:

• Typical Schedule/Shift: Varies depending on review volume; Utilization Management hours of operation are 8 AM – 5:30 PM EST.