HP Utilization Review-PT at Cook Children's Health Care System

Location:

Remote - TX

Department:

Utilization

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Responsible for the coordination and efficient utilization of therapy health care resources for Cook Children's Health Plan (CCHP) members. Works with the Department Manager to assure the provision of quality care throughout the continuum of care. The Physical Therapist Utilization Management (PT -UM) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers, health plan medical directors, and all other members of the health care and health plan team. The PT-UM Reviewer assesses and identifies the patient¡¦s clinical findings and determines, in conjunction with the Medical Director utilizes protocols, pathways, and evidence based clinical tools, to assess the level of therapy care appropriate for the member. The PT UM Reviewer communicates with providers of care/services to facilitate appropriate levels of therapy care. The PT UM Reviewer participates with the Department Manager reviewing and updating evidence-based standards of physical and other therapy care and services for CCHP.

Additional Information:

Responsible for the coordination and efficient utilization of therapy health care resources for Cook Children¡¦s Health Plan (CCHP) members. Works with the Department Manager to assure the provision of quality care throughout the continuum of care. The Physical Therapist Utilization Management (PT -UM) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers, health plan medical directors, and all other members of the health care and health plan team. The PT-UM Reviewer assesses and identifies the patient¡¦s clinical findings and determines, in conjunction with the Medical Director utilizes protocols, pathways, and evidence based clinical tools, to assess the level of therapy care appropriate for the member. The PT UM Reviewer communicates with providers of care/services to facilitate appropriate levels of therapy care. The PT UM Reviewer participates with the Department Manager reviewing and updating evidence-based standards of physical and other therapy care and services for CCHP.

Education:
Master's degree (M. A.) in Physical Therapy. Health plan utilization management experience preferred. Strong skills in the following areas. Oral and written communication. Critical thinking. Organization and time management. Customer service
Certification/Licensure:
Current, unrestricted licensure for Physical Therapist in the state of Texas

About Us:

Cook Children's Health Plan

Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region.  Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.

Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer.