Medical Reviewer (Physical Therapist)
New
G
Gainwell TechnologiesHealthcare, Medical Review
United StatesFull-TimeMiddle
Salary85,000 - 100,000 USD per year
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Job Details
- Experience
- Minimum of three (3) years of experience as a Physical Therapist.
Requirements
- Minimum of three (3) years of experience as a Physical Therapist.
- Graduation from an accredited school of Physical Therapy.
- California license to practice Physical Therapy, or eligibility for California licensure.
- Current professional certification in good standing.
- Strong clinical judgment and ability to interpret medical records, treatment plans, and therapy-related documentation.
- Strong written and verbal communication skills.
- Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams.
Responsibilities
- Review physical therapy-related medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documentation.
- Evaluate requested therapy services based on clinical documentation, medical policy, and applicable coverage requirements.
- Apply professional physical therapy principles and clinical judgment when supporting medical necessity and appropriateness determinations.
- Document review findings and clinical rationale accurately and timely.
- Refer cases requiring additional clinical review to appropriate medical professionals when needed.
- Collaborate with physicians, nurses, therapists, operations teams, and other healthcare professionals to resolve review questions.
- Maintain knowledge of applicable physical therapy standards, medical policies, coverage requirements, and regulatory guidelines.
- Meet established quality, accuracy, productivity, and turnaround-time expectations.
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