Duties and Responsibilities:

• Initial authorizations of outpatient physical therapy services: Reviews and authorizes services that meet criteria, along with supporting documentation. It is the responsibility of the URC to ensure outpatient physical therapy services are provided at the appropriate level and are received per the defined plan guidelines.
• Re-authorization/concurrent review for continued therapy: Reviews clinic documentation submitted by the provider to ensure services continue to meet defined plan guidelines.
• Care Management : Reviews all cases meeting criteria to determine if the member qualifies for TPTN’s internal Care Management program. Will facilitate all Care Management related communications being sent to the member.

Additional responsibilities include:

• Investigate and resolve questions related to authorization and claims activity.
• Assists in maintaining department compliance with state, federal, HIPAA and DOL regulations.
• Assists in resolving issues relative to clinical procedures.
• Participates in monthly Health Services Meetings.
• Potential for limited local travel to attend Client Health Fairs.

Qualifications and Experience :

Individual must be results and goal oriented. Must be self-directed and can communicate effectively, both orally and in writing. Computer experience required: Word, Excel, Internet.

• Two to five years of experience, preferably in a managed care environment
• Working knowledge of the physical therapy industry is a definite plus.
• Strong written and verbal communication skills.
• Strong customer service skills/experience.
• Strong computer skills a must (Word, Excel, etc.).
• Independent, self-starter who is results and goal oriented.

Education:

Healthcare professional with an acquired background in physical therapy. Must possess an Associate's Degree, Bachelor’s degree preferred. Experience in lieu of a degree will be considered.