What are the responsibilities and job description for the Utilization Management Specialist-PT/OT position at TruBlu HR Solutions?
A leading pediatrics healthcare organization in the Houston, TX area is seeking an experienced Utilization Management PT/OT Specialist for a 13-week contract role with the potential to transition to permanent employment.
Schedule: Monday–Friday, 8:00 AM–5:00 PM (overtime required)
Work Model: Hybrid – onsite attendance required for training, team meetings, town halls, and during internet or power outages
Start Date: 12/29/2025
Key Responsibilities:
• Provide prior authorization for outpatient and home physical and occupational therapy services requiring clinical review
• Apply clinical judgement, regulatory knowledge, product benefits, and evidence-based criteria to assess medical necessity
• Collaborate with physicians and therapists regarding patient history and current care needs
• Refer cases that do not meet medical necessity guidelines to the medical director for further review
• Enter clinical and authorization information accurately and in a timely manner
• Assign appropriate length of service according to guidelines and communicate authorization numbers to providers and members
• Evaluate benefit coverage and relevant regulatory requirements
• Support provider education as needed
Required Qualifications:
• Degree in Physical Therapy or Occupational Therapy
• Active Texas Physical Therapist or Occupational Therapist License
• Minimum of five (5) years of professional physical therapy and/or utilization management experience
• Experience with functional measurement or testing related to musculoskeletal, neurological, pulmonary, or cardiovascular systems
• Experience in rehabilitative treatment focused on restoring function, preventing disability, and supporting activities of daily living
• Ability to prevent, identify, and manage movement dysfunction or pain
• Strong computer proficiency and familiarity with general office and audio/video equipment
• Excellent written and verbal communication skills
• Ability to retain confidential patient information
• Highly motivated and able to work independently and collaboratively
Preferred Experience:
• Pediatric therapy
• Prior Utilization Management and/or Managed Care Organization (MCO) experience
If you meet these qualifications and are interested in a challenging and meaningful role in utilization management, please reach out for more details or to submit your resume.
Salary : $46 - $50