CQE Manager I-Rehabilitation Services-Physical Therapy (Remote)

American Specialty Health Incorporated is seeking a CQE Rehabilitation Services Manager I to join our Rehabilitation Services department. This position will render medical necessity review determination of services requested by Physical Therapy practitioners.

Requirements

• Professional degree in Physical Therapy from accredited college or university required
• A current, unrestricted license to practice in their health care specialty
• Minimum of 5 years of clinical experience
• Understanding of Physical Therapy evidence-based guidelines and best practices required
• Working knowledge of managed Physical Therapy services is a plus
• Advanced training or certification in any specialty areas of Physical Therapy, health care or quality management, case management, performance improvement, data analysis, and quality initiatives also preferred
• Must meet ASH clinical credentialing requirements
• Critical evaluation of submitted clinical documentation in order to make medical necessity determinations with the scope of accountabilities
• Ability to apply and communicate evidence-based criteria and approved guidelines to specific medical necessity review scenarios
• Ability to communicate clinical rational for medical necessity consistently, effectively, and in a professional manner