Utilization Management Medical RN Reviewer

Description:
This position is responsible for performing physical therapy reviews. This includes certification review, continued treatment review. May also include participating in team functions such as committees, QA team evaluations, and preceptorships. Able to initiate and complete certification review of physical therapy modalities Able to identify and refer cases NOT meeting established criteria to Healthcare Advisor Consultant. Criteria includes, but is not limited to: Milliman Guidelines Health Management Strategies (HMS) American Society of Addiction Medicine (ASAM) Managed Care Appropriateness Criteria (MCAP) Provide accurate information to callers as evidenced by computer entry/documentation Comply with protocols and QA requirements Process appeals as evidenced by compliance with protocols Able to function as training preceptor as evidenced by completion of trainee checklist. Participate in team meetings, committees, or committee assignments as evidenced by:
Completion of tasks assigned by team or committee Completion of team QA evaluation in compliance with QA protocol Present and participate in provider/subscriber and group in-services, workshops, and educational seminars regarding Utilization Management activities
Visit our website at:www.apshealthcare.comReferral bonus available to APS Healthcare Employees*
In accordance to guidelinesAPS HEALTHCARE Bethesda, Inc. and its subsidiaries and affiliates (APS) are Equal Opportunity Employers which employ qualified individuals based upon job related qualifications regardless of race, religion, color, sex, national origin, age, disability, or any other classification proscribed under applicable federal, state, or local law. APS complies with the law regarding reasonable accommodation for disabled employees. Applicants requiring reasonable accommodation in order to participate in the interview process are requested to contact Human Resources in order to arrange such accommodation.
REQUIREMENTS
Requirements:
Medical knowledge and background obtained by completion of a Physical Therapy program. A minimum of two years active experience in acute therapy care is required.Active unrestricted Physical Therapy license in Wisconsin . Valid Driver's license.Must be able to access, research and extract information from printed resources, computer terminals, medical records and telephone interviews on a daily basis. Must have strong organizational skills, the ability to follow directions, interpret instructions, and solve practical problems. Must have excellent communication skills and customer service acumen. Must be able to function independently, effectively, and cooperatively with little supervision, meet assignments, work with a variety of tasks simultaneously, do detailed work and follow tasks through to completion.Education:
Bachelors degree required.