Utilization Specialty Therapist

Title: Utilization Specialty Therapist

Location: Remote - TX

Duration: 09 Months

Summary

Team's purpose is to review prior authorization therapy requests for home health and outpatient agencies and determine if the request meets SHP therapy policy criteria.

Day to Day includes:

100% remote work.

Staff would login, open up all applications such as Outlook, Teams, Excel, OneNote, and TruCare Cloud, then check in with team and review email.

We use Cloud daily to pull work, review documentation/clinicals from providers, and enter reviews for various phases of prior auth (approvals, denials, partial approvals, and request for information).

We are a task-based team so our workload includes assigning and receiving tasks to manage auths/cases.

We pull and manage 15-40 auths per day so time management and understanding priority work is critical. We utilize a lot of technology so efficiently working through and troubleshooting applications is necessary day to day.

The day also includes phone calls to servicing providers to speak with admin staff and therapists (OT/PT/SLPs) to help resolve prior auth requests.

Team can make up to 15 calls in a day.

There are no specific projects, just managing volume of prior auth requests in all phases of the process and Turn around time (TAT) which is up to 14 days, phone calls, tasks in personal box, emails, and Teams messages is critical to the day.

The therapy team is very supportive so bringing a positive vibe to the group will be helpful.

Candidate Requirements

• Education/Certification : Required: Masters Degree Preferred:
• Licensure : Required: Texas Physical Therapist or Occupational Therapist Preferred:
• Years of experience required: 3 years minimum as licensed therapist- - lean heavy on pediatric reviews but adult exp ok. Microsoft Office experience. Must be comfortable with TEAMS, Outlook and One Note
• Disqualifiers: Residing outside of Texas
• Additional qualities to look for: Decisive, good time management, good with technology

Top 3 must-have hard skills stack-ranked by importance

• 1 Organized
• 2 Adaptable
• 3 Quick learner