Clinical Review Specialist - Part TimeGenex Service LLC

Genex Service LLC


Clinical Review Specialist - Part Time

US--Remote

Job ID: 25-18562
Type: Regular Part-Time
# of Openings: 1
Category: Medical Services & Support
Mitchell International, Inc.

Overview

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

 

Be part of a team that makes a real difference.

Responsibilities

You Must Reside in the Eastern or Central Time Zone

This is a Part Time Position at 20 hours a Week

 

The Clinical Review Specialist is a vital member of the Clinical Oversight Team within Apricus. This role involves reviewing physical therapy services for injured workers to ensure high-quality care and appropriate treatment. You will provide clients with updated clinical summaries and recommendations regarding continuation or discontinuation of therapy services. This position is available as a remote work opportunity with expectations for maintaining confidentiality of company and customer information.

 

Key Responsibilities:

Conduct reviews of physical or occupational therapy evaluation and treatment documentationPerform Peer-to-Peer communication with treating or supervising PTs and OTs via phone and/or email to review therapy care plans for injured workers covered by Workers Compensation claims. Utilize state and national disability guidelines to assess duration of care and provide clinical recommendations for ongoing therapy or discharge readiness.  Prepare detailed reports and clinical summaries with written support of recommendations for clientsMaintain communication with nurse case managers and other claim stakeholders as needed
• Collaborate with operations and clinical admin staff to ensure appropriate authorization
• Perform provider follow up regarding authorization and/or clinical recommendations

Provides clinical process assistance for various tasks such as process verification, clinical reviewer assistance, establishing and applying clinical review standards, and providing ongoing assessment of medical necessity and appropriateness, etc.. At the direction of the Clinical Management team, the associate will ensure that each review is carried out in compliance with any accreditation group/s standards (i.e. URAC), all applicable laws and regulations, and corporate policies. The role requires a healthcare background and current active licensure in the respective area to properly interpret the clinical information, clinical guidelines, standards, and jurisdictional rules and regulations in order to make correct recommendations to both non-clinical and clinical staff. The scope of work and specific duties are defined by the Clinical Management team. Licensed healthcare professional in the respective area of focus required (e.g. DC, RN, PT, OT, etc.).

Qualifications

Required Qualifications

Degree in Physical or Occupational Therapy with active license as Physical/ Occupational Therapist or Physical/ Occupational Therapist Assistant in the United States.Experience 3+ years in outpatient therapy settingExceptional communication skills, both written and verbal.Ability to provide comprehensive review reports for clientsDemonstrate ability to meet metrics for reviews case loadExcellent organizational skills with ability to prioritize work effectivelyProficiency with company software and equipment

Preferred Qualifications:

• Experience in Workers Compensation Industry
• Knowledge of industry standard treatment guidelines
• Experience in performing quality assessments and/or clinical chart reviews

Salary:



Equal employment opportunity, including veterans and individuals with disabilities.

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