Clinical Review Support Specialist (Physical Therapy)

TL;DR

Clinical Review Support Specialist (Physical Therapy): Supporting medical necessity review determinations for physical therapy services with an accent on provider communication, clinical coordination, and education. Focus on facilitating clinical reviews, collaborating with quality workgroups, and ensuring adherence to evidence-based guidelines.

Location: Must be based in the United States

Salary: $48,000–$60,000

Company

hirify.global is a national health services organization specializing in specialty health care programs and fitness and exercise programs.

What you will do

• Support medical necessity review determinations for physical therapy services.
• Perform outreach calls to network and non-network therapy practitioners.
• Determine and obtain appropriate clinical assessment for submitted diagnosis codes.
• Educate providers on submission processes, forms, and available resources.
• Facilitate clinical review coordination among Clinical Quality Evaluators.
• Collaborate with management on clinical program policies and protocol implementation.

Requirements

• Professional degree as Physical Therapy Assistant from an accredited institution.
• Current, unrestricted license to practice in a healthcare specialty.
• Minimum of 5 years of clinical experience.
• Understanding of therapy evidence-based guidelines and best practices.
• Stable home internet connection (minimum 50 down/10 up Mbps).
• Ability to work independently with minimal guidance.

Nice to have

• Post-graduate degree in a related field.
• Experience with care coordination or leadership.
• Working knowledge of managed therapy services.
• Advanced training or certification in quality management, case management, or data analysis.

Culture & Benefits

• Full-time employment with competitive compensation.
• Remote work environment with company-provided technology equipment.
• Opportunity to participate in clinical quality workgroups.
• Equal Opportunity Employer committed to a diverse and inclusive workplace.