Utilization Specialty OT Therapist Pediatric

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Perform utilization review of authorization requests regarding specialty therapy services for members, including speech language, occupational, and physical therapy across the identified regions and products. Assist with training and network management support for therapy providers.

We are looking for someone who has Home Health/Outpatient experience.

• Perform detailed review of therapy service requests based on evidenced based practice, documentation standards as indicated by the national therapy associations, and organizational policies.
• Refer members to case management as appropriate based on service request assessment.
• Provide clinical recommendations for any adverse therapy determination.
• Provide clinical expertise based on shared practice standards regarding sub-specialty therapy practice to peers.
• Provide support for specialty therapy providers, including assistance with clinical trainings, consultation and guidance on matters related to therapy authorization and provision.
• Provide clinical expertise to multi-functional areas within organization to support provider relations and operations.

Education/Experience: Master’s degree in area of specialty therapy or equivalent experience. 3+ years of experience providing therapy services in healthcare or home health settings. Pediatric clinical experience preferred.

Licenses/Certifications: Current state license in Occupational Therapy

We are looking for someone who has Home Health/Outpatient experience.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act