Note: The job is a remote job and is open to candidates in USA. Cohere Health provides clinical intelligence and AI-powered solutions that improve payer-provider decision-making and healthcare outcomes. The Clinical Reviewer, DPT will review clinical information, apply evidence-based guidelines, determine medical appropriateness for musculoskeletal and orthopedic services, and communicate review decisions with providers while supporting team and operational improvements.
Responsibilities
- Provide timely medical reviews that meet Cohere’s stringent quality parameters
- Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen
- Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision
- Use correct templates for documenting decisions during case review
- Meet the appropriate turn-around times for clinical reviews
- Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
- Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
- Support projects specific to building the team's clinical expertise and efficiency, as delegated
- Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated
Skills
- Doctor of Physical Therapy (DPT) from a CAPTE-accredited physical therapy program
- Active, unrestricted Physical Therapist license in the state of practice (or eligibility for licensure)
- 5 or more years of direct clinical patient care experience
- + Familiarity with facilities rendering care in PT, OT, SLP
- 1+ years of managed care utilization review experience, preferably in an utilization management organization within a Medicare, Commercial or Medicaid payor organization preferred
- Membership in national and/or regional specialty societies preferred
Benefits
- Fully remote opportunity
- Medical, dental, vision, life, and disability insurance
- Employee Assistance Program
- 401K retirement plan with company match
- Flexible spending account
- Health savings account
- Flex Time Off
- Company holidays
- Up to 14 weeks of paid parental leave
- Pet insurance
- Bonus
Company Overview