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Physical Therapist Utilization...

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Job Summary

Company
Anthem
Location
Westchester, IL
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS3637

Physical Therapist Utilization Reviewer - Recent Grads - Westchester, IL (PS3637)

About the Job

Description
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 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 Physical Therapist Utilization Reviewer at our Westchester, IL, contact center.
Physical Therapist Utilization Reviewer - Recent Grads - Westchester, IL
Physical Therapist Reviewers - Recent Grads 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 musculoskeletal procedures to ensure quality member outcomes, and to optimize member benefits.
This is an in-office, call center environment in the beautiful Westbrook Corporate Center.
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
  • Physical Therapist with a current, valid unrestricted license in the state of Illinois
  • New PT Graduate up to 2 years recent clinical experience in an ambulatory or hospital setting
  • Candidates should have Orthopedic or Neurosurgical Spine experience (school program, hospital, office or outpatient)
  • Candidates should have good computer skills and solid typing speed and accuracy
  • Familiarity with managed health care programs including HMO, PPO, and POS from PT program
  • 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
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
 

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