Physical Therapist Clinical Reviewer
Are you looking for an impactful role where you finish the workday knowing you helped someone? Whether you’re joining our care coordination team or playing a supporting role, the work you do every day helps us collectively reach our mission of “getting people the care they need when they need it.” We believe that by staying committed to our core values of Think Big, Go Fast, Deliver Awe, and Win Together, we can positively impact the lives of the injured workers we serve and get them back to the things that matter most in life.
Salary Range: $66100 - $109100 Salary
This compensation range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At One Call, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $66100 - $109100 Salary
Benefits Summary:
In return for your commitment to our company’s mission, we offer a vast array of benefits to help support the whole you.
- Opportunities to work from home
- Competitive wages with opportunities to earn annual merit increases
- Paid development hours to use for professional and community development!
- 18 days of Paid Time plus 8 company holidays, and 2 personal days per year
- $1,000 Colleague Referral Program
- Enterprise Recognition Program rewarding colleagues for their extraordinary work
- Exclusive discounts on travel, activities, and merchandise via work discount program
- Colleague Assistance Program that provides free counseling and financial services
- Tuition Reimbursement Program including certifications
- Quantum Health: A healthcare navigation platform to help our colleagues make the best, most cost-effective healthcare decisions
- Medical, dental, and vision insurance
- Pre-Tax FSA and HSA health savings accounts
- Company paid life insurance
- Company paid short term and long-term disability
- The One Call Foundation which aims to help colleagues during unexpected emergencies, from car accidents to natural disasters.
JOB SUMMARY:
Responsible for completing clinical QA audits and/or plan of treatment reviews specific to their licensure and scope of practice. Reviews to provide recommendations related to the medical necessity for ongoing care, progression of treatment, appropriateness of past treatments, and billing accuracy. The Clinical Reviewer’s primary stakeholder is the client (Adjuster/NCM) and must ensure their review/explanation assists and does not hinder the client from making the best decision on how to proceed with the file regardless of their opinions on the treatment that should be performed. Also responsible for providing clinical expertise and collaboration on other One Call processes and customer issue resolutions.
Physical Therapy Clinical Reviewer I
Minimum bachelor’s degree (B.A. or B.S.) and current physical or occupational therapy license and practiced for a minimum of 5 years within an outpatient orthopedic setting. Worker’s compensation treatment experience strongly preferred but not required. Entry level reviewer role. Demonstrates strong clinical knowledge and experience to apply to clinical review/QA. Generally, performs standard Clinical QA reviews. Works under supervision of Clinical Review Supervisor, but with latitude to make independent clinical recommendations. Consults with senior peers and team leads on non-complex issues to learn through experience. Can talk with treating practitioners and network providers about standard One Call clinical program features and benefits. Understands appropriate communication protocols and standard workers compensation workflows from a treating practitioner perspective.
GENERAL DUTIES & RESPONSIBILITIES:
Review Evaluations, plan of treatments, progress notes, and other clinical documentation and provide a report of clinical guidance to client within 48-72 hours of request, dependent on type.
Responsible for calling the treating provider to discuss findings and recommendations, with the goal of securing mutual agreement, and to coordinate communication to patient and MD of any revised plan of treatments.
May be responsible for calling client to discuss authorization and/or follow up on Plans of Treatment, continuation of care, or other clinical treatment recommendations.
Responds to the financial team’s requests within 48 hrs. to assist in processing claims received.
Acts as a resource for other staff, answering questions and giving guidance when needed on clinical questions within their scope of practice.
Collaborates with Operational leaders to share opportunities for improvement with referral data quality.
Works all special reports distributed by a supervisor/manager.
Reviews and responds to any requests from clients, provider, claimant, or supervisor and performs necessary action steps within 48 hrs.
Consistently demonstrates a positive attitude and an overall commitment to excellence and is a team player.
Actively participates in continuous operational improvements. Specific activities include, but are not limited to, offering feedback to management related to process, working closely with provider development team to address provider issues, collaborating with financial team to improve efficiency and participates in training/mentorship initiatives.
Assists in obtaining necessary clinical documentation from provider as needed.
Is open to coaching and willing to find more efficient processes when applicable.
Performs miscellaneous tasks and projects as assigned by management.
Demonstrates knowledge of CPT and ICD9/10 codes
Reviews and corrects in-accurate coding on referral.
Assists in provider appeals related to authorization or payment as needed and related to clinical determination.
Participates in provider scoring and complaint review as requested.
Utilizes and maintains general knowledge of insurance reimbursement and specific knowledge of One Call Care Management processes.
Participates in staff meetings, office presentations, training, orientation, and conference calls, as directed.
May participate internal file QA to ensure appropriate care coordination internally.
Can always maintain professional composure and demeanor with both internal and external communications and interactions, including discussing modified/reduced treatment with our providers.
EDUCATIONAL AND EXPERIENCE REQUIREMENTS:
Minimum bachelor’s degree (B.A. or B.S.) and current physical or occupational therapy license and practiced for a minimum of 5 years within an outpatient orthopedic setting. Worker’s compensation treatment experience strongly preferred but not required.
GENERAL KNOWLEDGE, SKILLS & ABILITIES:
Ability to read, analyze and interpret a vast variety of both handwritten and electronic medical reports, professional journals, newsletters, technical procedures, and/or government regulations. Ability to write business correspondence and completion of business forms.
Ability to effectively present information and respond to questions from colleagues, Adjustors, Nurse Case Managers, Providers and Provider’s office staff.
Ability to create and utilize Microsoft Word documents and Excel spreadsheets.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Must have the ability to work with and have knowledge of the physician community, managed care, pre-certification, and utilization review.
Must have knowledge of workers’ compensation.
Must be able to collaborate with individuals at all levels of the organization.
Knowledge of the Internet and how to research information is preferred.
Must be able to maintain a professional appearance and exhibit strong interpersonal, verbal, and written communication skills for both internal and external customers, including discussing modified/reduced treatment with our providers.
Must be able to organize work to ensure tasks are completed in a timely manner.
Ability to respond to common inquiries or complaints from customers.
To perform this job successfully, an individual should have knowledge of Microsoft Word; Microsoft Works; Microsoft Excel; Microsoft Internet Explorer; and Microsoft Outlook.
Confidentiality of One Call business intellectual property and information
Current Physical or Occupational Therapy license required, license must be in good standing with Office of Inspector General (OIG) and National Provider Database (NPDB).
One Call may check licensure at time of employment and at discretion at any time during employment.
Maintain licensure and provide One Call annual proof of compliance.
Maintain ongoing Continuing Education Units (CEUs) as required under personal licensure.
Must be licensed in the US.
PHYSICAL/EMOTIONAL DEMANDS & WORK ENVIRONMENT:
For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear.
The employee is occasionally required to lift objects (up to 10lbs weight; up to 4 ft. height).
Specific vision abilities required by this job include ability to see things from a close distance and to adjust focus.
The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload.
Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position.
Please be advised this job description is subject to change at any time.
