Clinical Review Support Specialist

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

Salary Range

American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate’s qualifications education skill set years of experience and internal equity. $48000 to $60000 Full-Time Annual Salary Range.

Remote Worker Considerations

Candidates who are selected for 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 remote/WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).

Responsibilities

• Support of medical necessity review determinations.

• Perform outreach 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 Therapist Assistant from accredited college or university required. Additional post-graduate degree in same or related field a plus.

• A current unrestricted license to practice in their health care specialty. Employees must maintain a current unrestricted license to practice and must be in good standing with all 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 related 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 MS Word IHIS ASHCore.

• Ability and willingness to serve as a resource for practitioners to educate them how to operate within ASH programs and systems most effectively and efficiently.

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 develop effective solutions.

• Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary able to sit for long periods of time.

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 within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

Environmental Conditions

Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race color religion sex including sexual orientation and gender identity national origin disability protected Veteran Status or any other characteristic protected by applicable federal state or local 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 inquired 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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