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Speech Therapist UM Reviewer

  • Ref: 282672
  • Type: Direct Hire
  • Location: Fort Lauderdale, FL
  • Industry: Insurance
  • Job Level: Experienced Non-Manager
  • Pay: $71,000 - $75,000

Opportunity Description

Our client, a Care Mangement Organization, is seeking a Speech Therapist UM Reviewer for a Direct Hire position. The Speech Therapist UM Reviewer will be responsible for clinically reviewing requests for PT services in a timely manner utilizing established clinical guidelines and Utilization Management protocols to evaluate for the medical necessity and appropriateness of the requested PT services.

Job Duties

  • Responsible for making favorable organization determination and escalating cases deemed not medically necessary to the Medical Director.
  • Perform Peer to Peer discussions with requesting provider.
  • Clinically review requests for ST services and submitted by the Coordinator who prepares the code for review.
  • Review supporting clinical information: Evaluation, Plan of Care with standardized test scores, and Progress Notes in a timely manner.
  • Determine if services are medically necessary and if the Plan of Care is appropriate for treatment modality.
  • Document determination and provides a clinical report identifying instances where a provider shows a trend and educational opportunity.
  • Is available for Peer to Peer Consultation with any therapist upon request or when a Plan of Care does not follow appropriateness according to clinical guidelines before submitting the case to the Medical Director for final review, and determination.
  • Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
  • Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
  • Ability to come to work and work the regular schedule and shift for the position.
  • Perform additional duties and related essential duties as assigned.
  • Compliance with all personnel policies and procedures.

Experience & Skills Required

  • Minimum of 5 years of clinical experience in a medical/hospital/clinic setting.
  • Managed care experience preferred.
  • Reviewer Experience for a CMO or Health Plan company
  • Candidate must be interested in being on the administrative side of the business versus a therapist in the field.

Certifications

Licensed Speech Therapist in the State of Florida. The incumbent will be required to procure their GA license after being hired. Other states must be obtained if requested.

Languages

Bilingual Spanish preferred.