UM Physical Therapist (TX STAR Kids)

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This position is office based. The Utilization Management (UM) Physical Therapist utilizes physical therapy training and clinical skills to review, document and communicate all aspects of physical therapy services utilization to determine appropriate plan benefits.

The post requires the employee to:
• Utilize physical therapy/rehabilitative clinical experience and skills in a collaborative process to review episodes of care to administer appropriate coverage decisions/benefits for members.
• Gather clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determinations or recommendations.
• Communicate coverage determinations to providers and members. Identifies members for referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to other internal and external constituents in the coordination and administration of benefits coverage.

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