Therapist Reviewer at Elevance Health

Indiana, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Graduate of a college level program in physical therapy or an accredited two-year program for a Physical Therapist Assistant
Minimum of 1 year of clinical experience (or equivalent combination of education and experience)
Current active unrestricted license or certification as a physical therapist assistant in applicable state
Certification and/or licensure appropriate to field of specialty as required
Within reasonable commuting distance from Fort Wayne, Indiana (unless accommodation granted)

Responsibilities

Apply professional therapy, government regulation, and medical policy knowledge to medical review and make determinations for authorization requests, meeting contract requirements, processes, and operational unit goals to ensure customer satisfaction
Document findings, develop analyses, and submit reports to appropriate departments in accordance with government regulations and requirements
Research and obtain additional data, consult with clinical reviewers and medical directors when necessary
Act as a resource for internal and external customers
Participate in intradepartmental teams, projects, and initiatives
Maintain quality and productivity standards and ensure reviews are conducted within required timeframes
Provide comprehensive support and assistance to faculty and staff in Fort Wayne, Indiana, serving employees through preventative care, immediate consultation, and appropriate referrals (hybrid model: home and in schools)

Skills

Physical Therapy

Sports Medicine

Musculoskeletal Health

Medical Review

Government Regulations

Medical Policy

Clinical Consultation

Authorization Requests

Report Documentation

Quality Standards

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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