Occupational Therapist-Utilization Management

 
Position: Occupational Therapist-Utilization Management

Job ID: 149610

Location: US-TX-Bellaire

Department: Utilization Management

Talent Area: Professional - Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8am-5pm

About Texas Children's Hospital

Texas Children’s Health Plan (TCHP) is the largest Texas Medicaid managed care organization, and is part of the Texas Children’s healthcare system. Founded in 1996, TCHP is the nation's first health maintenance organization (HMO) created just for children and pregnant women. Our plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. Currently the Health Plan serves more than 450,000 members across three service areas (Harris, Jefferson, North East). Members of the plan receive care from our network of more than 4,000 primary care physicians, 8,000 specialists, and 110 hospitals. They can also receive care at The Center for Children and Women, a patient and family-centered medical home with two convenient locations for TCHP members who can have all their medical needs met in one place, receiving multiple services the same day. TCHP is a recognized leader at encouraging holistic care that empowers families to live healthier lives.   To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities.   You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for a  Occupational Therapist-Utilization Management— someone who works well in a fast-paced setting. In this position, you'll provide prior authorization of outpatient, home physical, and occupational therapy services requiring approvals.

This process includes using clinical judgment for utilization management, application of product benefits, understanding of regulatory requirements, and verification of medical necessities.

 

Think you’ve got what it takes?



Responsibilities :

  • Utilizes set criteria to certify requested services are certified within the established timeframe
  • Reviews all demographic information generated by the utilization management assistant staff and communicates variances
  • Collaborates with all disciplines within the health plan to meet goals and objectives
  • Screens, identifies, and refers potential members to case management
  • Identifies potential quality of care issues, documents in the electronic system, and refers to appropriate quality management staff
  • Ensures that non-licensed staff function within the guidelines of regulatory standards and contractual requirements
  • Promotes provider satisfaction with ongoing education regarding managed care and the process and procedure of the authorization requirements


Qualifications:

  • Degree in Physical or Occupational Therapy, master’s degree preferred
  • PT-Physical Therapist or OT- Occupational Therapist License from The Texas Board of Physical or Occupational Therapy Examiners
  • 5 years of experience in professional physical therapy and/or utilization management experience

 



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