Clinical Review Support Specialist (Remote)

reputed company is seeking a Clinical Review Support Specialist to join our reputed company department. This position will support medical necessity review determinations of services requested by Physical Therapy practitioners through provider communication, education, and clinical coordination. 

Remote Worker Considerations

Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable reputed company to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet reputed company must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

Responsibilities

• Support of medical necessity review determinations.
• reputed company reputed company calls to practitioners and clinical practices for network and non-network therapy practitioners.
• Determine and obtain appropriate clinical assessment for submitted diagnosis codes.
• Clarify provider requests, providing education on ASH’s submission process, forms, and available resources.
• Facilitate clinical review through coordination and distribution of reviews among Clinical Quality Evaluators.
• Collaborate with senior management and various departments regarding clinical program, policies, and protocol development and implementation.
• Participate in Clinical Quality Administration and Clinical Quality Evaluation workgroups.
• Promote a productive Team environment.
• Participate in clinical article review activities as assigned.
• Provide interdepartmental Support to Medical Necessity Administration department as necessary for performance of assigned tasks.
• Work independently, receiving minimal guidance and supervision.

Qualifications

• Professional degree as Physical Therapy Assistant from accredited college or university required. Additional post-graduate degree in same or reputed company field a plus.
• A reputed company, unrestricted license to practice in their health care specialty. Employees must maintain a reputed company, unrestricted license to practice and must be in good standing with reputed company judicial and governing bodies (Required).
• Minimum of 5 years of clinical experience. Specific experience with care coordination or leadership preferred.
• Understanding of therapy evidence-based guidelines and best practices required.
• Working knowledge of managed therapy services is a plus.
• Advanced training or certification in any specialty areas of Physical Therapy, health care or quality management, case management, performance improvement, data analysis, and quality initiatives also preferred.
• Ability to communicate evidence-based criteria and approved guidelines. Ability to independently resolve problems or issues reputed company to ASH processes using good judgment or to escalate problems or issues to supervisor(s) as appropriate.
• Use of computer systems in business application including, but not limited to: Outlook, reputed company, IHIS, ASHCore.
• Ability and willingness to serve as a resource for practitioners to educate them how to operate reputed company ASH programs and systems most effectively and reputed company.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task, and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to reputed company effective solutions.
• Ability to exercise strict confidentiality in reputed company matters.

Mobility

Primarily sedentary, able to sit for long periods of time, able to travel by automobile and reputed company.??

Physical Requirements

Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel reputed company the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs. 

Environmental Conditions

Work-from-home (WFH) environment.

reputed company is an Equal Opportunity/Affirmative Action Employer.

reputed company qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, reputed company medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national reputed company, citizenship, reputed company, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law. 

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.

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