Utilization Review, Health Plan - Occupational Therapist

Location:

Calmont Operations Building

Department:

Utilization

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Responsible for the coordination and efficient utilization of therapy health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager to assure the provision of quality care throughout the continuum of care. The Occupational Therapist Utilization Management (OT -UM) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers, health plan medical directors, and all other members of the health care and health plan team. The OT-UM Reviewer assesses and identifies the patients clinical findings and determines, in conjunction with the Medical Director utilizes protocols, pathways, and evidence based clinical tools, to assess the level of therapy care appropriate for the member. The OT UM Reviewer communicates with providers of care/services to facilitate appropriate levels of therapy care. The OT UM Reviewer participates with the Department Manager reviewing and updating evidence-based standards of occupational and other therapy care and services for CCHP.

Additional Information:

Responsible for the coordination and efficient utilization of therapy health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager to assure the provision of quality care throughout the continuum of care. The Occupational Therapist Utilization Management (OT -UM) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers, health plan medical directors, and all other members of the health care and health plan team. The OT-UM Reviewer assesses and identifies the patients clinical findings and determines, in conjunction with the Medical Director utilizes protocols, pathways, and evidence based clinical tools, to assess the level of therapy care appropriate for the member. The OT UM Reviewer communicates with providers of care/services to facilitate appropriate levels of therapy care. The OT UM Reviewer participates with the Department Manager reviewing and updating evidence-based standards of occupational and other therapy care and services for CCHP.

Education:

• Bachelors or Master's degree in Occupational Therapy.
• Health plan utilization management experience preferred.
• Strong skills in the following areas: oral and written communication, critical thinking, organization and time management, and customer service.

• Current, unrestricted licensure for Occupational Therapist in the state of Texas.