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Position:&nbsp; Therapist/ UM Therapy Reviewer&nbsp;Reports To: Manager, Utilization Management&nbsp;Salary Range:&nbsp; DOEPosition Description: Therapist Reviewers are responsible for conducting re-authorization/certification and authorization activities for therapy home health services, by utilizing appropriate company policies, Medicare Chapter 7, Milliman Care Guidelines, and clinical department guidelines. They collaborate with healthcare providers to promote the most appropriate, highest quality and effective use of physical, occupational therapy and speech language pathology visits to ensure quality member outcomes, and to optimize member benefits.Essential Functions:<ul><li>Responsible for the review of medical records, including more complex cases, to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) are medically necessary.</li><li>Provides and/or facilitates clinical management and/or other related activities and serves as a resource to other team members while demonstrating fiscal responsibility and maintaining the highest standards of care and ensuring compliance with all policies, procedures, and regulatory requirements. Promotes interdisciplinary health plan consumers/beneficiaries’ care planning and supports questions from nurses in addition to agency, physician, member/family calls, etc.</li><li>Applies professional therapy, NCQA standards, CMS and Medicaid government regulation and medical policy knowledge to medical review, and makes determinations for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction.</li><li>Maintains knowledge of regulations and requirements through review of current regulations and/or policies. Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with regulations and requirements. Research and obtain additional data, consult with clinical reviewers and medical directors, when necessary.</li><li>Acts as a resource for internal and external customers. Participates in or leads intradepartmental teams, projects, and initiatives. Maintains quality and productivity standards, and ensures reviews are conducted within the required timeframes.</li><li>Periodic Weekend and Holiday Rotation based on business needs</li><li>Collaborate with colleagues to enhance their understanding of key considerations when reviewing therapy-related approvals and denials, including required documentation and criteria.</li><li>Develops and maintains positive customer relations and coordinates with various departments within the company to ensure customer requests and questions are handled appropriately and in a timely manner.</li><li>Other duties as requested.</li></ul>Office Location:<ul><li>Office located at 7600 North 16th Street Suite 140 Phoenix, AZ 85020</li><li>Remote</li></ul>Qualifications:<ul><li>Requires graduate of a college level program in physical therapy, occupational therapy or speech language pathology.</li><li>Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.</li><li>Current active unrestricted license or certification as a PT, OT or SLP required in applicable states.</li><li>Working knowledge of home care process and CMS regulatory and federal requirements.</li><li>Ability to exercise initiative and independent judgement.</li></ul>Knowledge and Experience:<ul><li>Requires extensive knowledge in the areas of home health community-based physical, occupational therapy and speech language pathology services and utilization/case management.</li><li>NCQA and URAC knowledge is helpful.</li><li>Excellent organizational, human relations, and communication skills are required to maintain good rapport and effective working relationships with internal and external customers.</li><li>3 years of home health experience is preferred.</li><li>Managed care, utilization review/management or case management experience preferred</li><li>Computer skills such as MS Office products - Outlook, Excel, Word, Adobe, and the ability to work within multiple medical management systems</li></ul>tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship

tango

Utilization Management Therapist Reviewer

Arizona Kidney Disease and Hypertension Center (AKDHC) is one of the nation's largest groups of physicians specializing in the care of patients with Chronic Kidney disease. Since 1976, we have enjoyed the trust of patients and the respect of the community throughout the Phoenix Metropolitan area and across Arizona. We are a professional medical association consisting of physicians and other vital support staff. To learn more about us, please visit our website: <a href="http://www.akdhc.com.&amp;nbsp" target="_blank">www.akdhc.com.&amp;nbsp</a>;Registered Nurse (RN) - AKDHC Marana Access Surgery CenterThis RN provides pre-operative, intra-operative, and post-operative care to patients per physician’s orders. Assists during interventional and surgical operating room procedures.Essential Duties and Responsibilities:<ul><li>Prepares the patient for the medical procedure according to established guidelines.</li><li>Ensures documented informed consent has been received from the patient prior to administering sedation.</li><li>Administers medication as needed.</li><li>Administers IV therapy and other therapeutic and diagnostic measures.</li><li>Facilitates patient transfer to EMS and hospital facilities.</li><li>Expedites timely and smooth flow of patients through the Access Center.</li><li>Completes patient assessments for potential problems with patency and other indicators of dialysis access.</li><li>Maintains accurate and complete medical records.</li><li>Provides patient education and instructions on home care and documents patient’s understanding.</li><li>Uses equipment standard to the profession, such as cardiac monitors, oxygen administration systems, and stethoscopes.</li><li>Performs crash cart maintenance and defibrillator checks.</li><li>Enters pertinent information in the computer system designed for statistical analysis, research, and patient follow-up.</li><li>Maintains Infection Logbook.</li><li>Assists with maintaining adequate supply and medication inventory.</li><li>Complies with current OSHA guidelines.</li><li>Maintains the patient's right to privacy.</li><li>Participates in the Quality Assurance (QA) Program.</li></ul>Qualifications/Skills:<ul><li>Associate's degree (A. A.) or equivalent from two-year college or technical school</li><li>Two years of acute or critical care experience is preferred in addition to experience with Conscious Sedation.</li><li>Current Arizona Registered Nurse License, current certification in Basic Life Support, and current ACLS certification.</li></ul>Benefits:We value our employees’ time and efforts. Our commitment to your success is enhanced by our competitive compensation and extensive benefits package including paid time off, medical, dental and vision benefits and future growth opportunities within the company. Plus, we work to maintain the best possible environment for our employees, where people can learn and grow with the company. We strive to provide a collaborative, creative environment where each person feels encouraged to contribute to our processes, decisions, planning, and culture.We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Insperity

Registered Nurse - Marana Access Surgery Center

Arizona Kidney Disease and Hypertension Center (AKDHC) is one of the nation's largest groups of physicians specializing in the care of patients with Chronic Kidney disease. Since 1976, we have enjoyed the trust of patients and the respect of the community throughout the Phoenix Metropolitan area and across Arizona. We are a professional medical association consisting of physicians and other vital support staff. To learn more about us, please visit our website: <a href="http://www.akdhc.com" target="_blank">www.akdhc.com</a>.Registered Nurse (RN) - AKDHC Phoenix Access Surgery CenterThis RN provides pre-operative, intra-operative, and post-operative care to patients per physician’s orders. Assists during interventional and surgical operating room procedures.Essential Duties and Responsibilities:<ul><li>Prepares the patient for the medical procedure according to established guidelines.</li><li>Ensures documented informed consent has been received from the patient prior to administering sedation.&nbsp;</li><li>Administers medication as needed.&nbsp;</li><li>Administers IV therapy and other therapeutic and diagnostic measures.&nbsp;</li><li>Facilitates patient transfer to EMS and hospital facilities.&nbsp;</li><li>Expedites timely and smooth flow of patients through the Access Center.&nbsp;</li><li>Completes patient assessments for potential problems with patency and other indicators of dialysis access.&nbsp;</li><li>Maintains accurate and complete medical records.&nbsp;</li><li>Provides patient education and instructions on home care and documents patient’s understanding.&nbsp;</li><li>Uses equipment standard to the profession, such as cardiac monitors, oxygen administration systems, and stethoscopes.&nbsp;</li><li>Performs crash cart maintenance and defibrillator checks.&nbsp;</li><li>Enters pertinent information in the computer system designed for statistical analysis, research, and patient follow-up.&nbsp;</li><li>Maintains Infection Logbook.&nbsp;</li><li>Assists with maintaining adequate supply and medication inventory.&nbsp;</li><li>Complies with current OSHA guidelines.&nbsp;</li><li>Maintains the patient's right to privacy.&nbsp;</li><li>Participates in the Quality Assurance (QA) Program.</li></ul>Qualifications/Skills:<ul><li>Associate's degree (A. A.) or equivalent from two-year college or technical school&nbsp;</li><li>Two years of acute or critical care experience is preferred in addition to experience with Conscious Sedation.&nbsp;</li><li>Current Arizona Registered Nurse License, current certification in Basic Life Support, and current ACLS certification.</li></ul>Benefits:We value our employees’ time and efforts. Our commitment to your success is enhanced by our competitive compensation and extensive benefits package including paid time off, medical, dental and vision benefits and future growth opportunities within the company. Plus, we work to maintain the best possible environment for our employees, where people can learn and grow with the company. We strive to provide a collaborative, creative environment where each person feels encouraged to contribute to our processes, decisions, planning, and culture.We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

3 Mental Health / Wellness Jobs in Arizona