Clinical Analyst Level IJob Description
Primary Duties & Responsibilities
- Clinical Oversight:
- Confirming attendance of initial evaluation (IE) and receipt of IE Report
- Reviews documentation and updates cases with accurate clinical information, including but not limited to ICD codes, Date of Surgery, Clinical Guidelines, ROM/Strength measurements
- Initiates review for requested service upon referral
- Review types include Continued Authorization and Internal Clinical Reviews
- Obtains, compiles, proofs and processes information received from providers/adjusters to aid in the final determination of a clinical reviewer.
- Reviews all assigned cases to provide efficient, cost-effective and quality utilization review services.
- Teleservices:
- Opens new Telerehab cases in the system and participates in scheduling injured workers for Telerehab
- Manages phone calls coming into department through the Telerehab Queue (internal and external calls)
- Monitors and handles Telerehab inbox including email, voicemail and fax communications for Teleservices team
- Participates in processing continued authorization for Telerehab cases including communication with physician offices and adjusters
- Handles other Teleservices duties as assigned
Primary Duties & Responsibilities
- Overall Duties:
- Documents all pertinent clinical patient/case information and actions into the case notes.
- Complies with all established policies and procedures
- Assists manager and team in quality improvement projects to provide instructive feedback to practitioners within scope
- Attends meetings and trainings.
- Meets quality management standards.
- Performs activities within the scope of professional licensure.
- Completes other duties and projects as assigned.
Qualifications
- Must hold a current Philippines Physical Therapy License
- Experience: 2-3 years of outpatient hospital clinic setting strongly preferred
- Knowledgeable of current physical medicine treatments
- Excellent verbal and written communication skills
- Organizational skills, prioritization, problem-solving and decision making skills are required
- Ability to multi-task in a fast paced environment
- Must be computer literate and be able to use the keyboard accurately. Experience with Microsoft Office and Zoom app are desired.
- Strong analytical and interpersonal skills are also required.
- Not required, but desired: current US Physical Therapy license and/or Doctor of Physical Therapy degree
- Experience in utilization review, case management, quality improvement and/or managed care is desired
