CQE Rehabilitation Services Manager I (Physical Therapy) (Remote)

TL;DR

CQE Rehabilitation Services Manager I (Physical Therapy): Manage medical necessity review of rehabilitation services requested by Physical Therapy practitioners for health plan members with an accent on evidence-based clinical decision-making, consistent review quality, and regulatory/accreditation audit readiness. Focus on communicating clinical rationale, supporting credentialing and medical record review, and collaborating on clinical program and protocol development while working independently in a remote WFH setup.

Location: United States; Remote (WFH)

Salary: $69,200–$93,000 Full-Time Annual Salary range

Company

hirify.global provides healthcare-related services and programs.

What you will do

• Manage medical necessity review of rehabilitation services for network and non-network Physical Therapy practitioners.
• Conduct timely, accurate, and consistent (inter- and intra-) reviews to verify and approve medically/clinically necessary care.
• Communicate clinical decision rationale to peers using evidence/outcomes-based principles.
• Support clinical credentialing and medical record review of network practitioners as needed.
• Review files in regulatory, accreditation, health plan, and medical group audits as required.
• Participate in clinical quality administration/evaluation workgroups and provide interdepartmental support for medical necessity administration.

Requirements

• Professional degree in Physical Therapy from an accredited college or university (required).
• Current, unrestricted license to practice Physical Therapy and in good standing (required).
• Ability to obtain additional unrestricted state licensure if required by business needs (required).
• Minimum of 5 years of clinical experience; medical necessity case review experience preferred.
• Understanding of Physical Therapy evidence-based guidelines and best practices (required).
• Use of computer systems in business applications (e.g., Outlook, MS-Word, IHIS, ASHCore) (required).

Culture & Benefits

• Work-from-home (WFH) environment with company-provided technology equipment.
• Stable internet required for video meetings: minimum 50 Mbps down / 10 Mbps up (100 down / 20 up recommended).
• Opportunity to work independently with minimal guidance and supervision.
• Emphasis on confidentiality, accuracy, productivity, and a productive team environment.

Hiring process

• Remote training for the role.
• Interviews and evaluation of clinical experience, licensure, and ability to perform medical necessity reviews.