Location: This position can be located anywhere within 50 miles of our Elevance PulsePoints.
The SLPTherapist Reviewer Sr will be responsible for the review of medical records, including more complex cases, to determine if requests for therapy services are medically necessary and filed appropriately.
How you will make a difference:
Applies professional therapy, government regulation and medical policy knowledge to medical review, and makes determinations for authorization requests, meeting all contract requirements, processes and operational unit goals to ensure customer satisfaction.
Maintains knowledge of regulations and requirements through review of current regulations and/or policies.
Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements.
Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary.
Acts as a resource for internal and external customers.
Participates in or leads intradepartmental teams, projects and initiatives. Maintains quality and productivity standards, and ensures reviews are conducted within required timeframes.
Minimum Requirements:
Requires a graduate of a college level program in speech language pathology and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current active unrestricted license as speech language pathologist in applicable state required.
Licensure appropriate to field of specialty as required.
