Utilization Specialty Therapist

Position Title: Utilization Specialty Therapist

Work Location: Remote- Texas

Assignment Duration: 9 Months

Work Schedule: M-F 8 AM-5 PM CST

Work Arrangement: Remote (Texas)

Position Summary:

The purpose of the Utilization Specialty Therapist is to apply clinical expertise and The Organization therapy policy when reviewing prior authorization requests to ensure services meet established practice standards, policy requirements, and medical necessity criteria, supporting appropriate utilization and quality outcomes for our members.

Background & Context:

Need: higher volume of requests to review than anticipated. Culture: fast paced, collaborative, purpose driven, remote but stay connected through Teams chats and meetings. Also hiring temporary workers for PT and OT and recently hired temporary workers for Intake and back end staff all due to high volume which is expected to decrease.

Key Responsibilities:

• The Utilization Specialty Therapist reviews and evaluates therapy prior authorization requests in accordance with The Organization therapy policies, established clinical standards, and departmental processes.
• The role is responsible for managing new and ongoing authorization requests to ensure timely, accurate, and thorough clinical review while prioritizing workload to meet established turnaround times and quality standards.
• Responsibilities also include monitoring email and Teams for operational updates, escalations, and time-sensitive matters; collaborating with team members and leadership to promote consistency, efficiency, and appropriate utilization of therapy services; and participating in required meetings, corporate training, and performance initiatives.
• The Utilization Specialty Therapist contributes to positive member outcomes while supporting the organization's commitment to transforming the health of the community, one person at a time.
• Performance expectation: maintain turn around time, quality clinical reviews, complete expected number of work items required per day based on business needs.

Qualification & Experience: