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$1,500 Sign-On Bonus - Physical Therapist Utilization Reviewer – Hanover, MD - PS12709 in Hanover, MD at Anthem, Inc.

Date Posted: 9/14/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.  
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
$1,500 Sign-On Bonus - Physical Therapist Utilization Reviewer – Hanover, MD
The Physical Therapist Utilization Reviewer is responsible for performing medical record reviews specific to services billed related to physical therapy with adherence to all contract requirements, ISO processes and operational unit goals to ensure customer satisfaction.  Additional responsibilities include collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for more complex medical issues
Primary duties may include, but are not limited to:  
  • Conducts precertification to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Conducts medical review/claim review of beneficiary health records specific to therapy services in support of investigations, cases, law enforcement requests and other activities.
  • Documents findings, develops, analyses and submits necessary reports to the appropriate departments in accordance with regulations and requirements.
  • Codes and prices complex claims using ICD-9, HCPCS and CPT manuals and coding guidelines when necessary as it relates to therapy services.
  • Researches and obtains additional data, when necessary.
  • Acts as a resource for internal and external customers.
  • Maintains productivity standards and ensures reviews are conducted within required timeframes.

  • Requires BA/BS in physical therapy: 3 years clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current licensed physical therapist in the state of Maryland, required.
  • Previous managed care experience preferred.  
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.