CQE Manager I-Rehab Services-Occupational Therapy (Remote)

Description

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 Occupational Therapy practitioners.

Remote Worker Considerations

Candidates who are selected for this position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This remote / WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).

Responsibilities

• Manage the medical necessity review of rehabilitation services.
• Performs medical necessity review of requested services from network and non-network Occupational Therapy practitioners.
• Conduct timely, accurate, and (inter- and intra-) consistent reviews in order to verify and approve medically / clinically necessary and appropriate care and services for our health plan members.
• Effectively communicate rationale for clinical decision making to peers using evidence / outcomes-based principles and professional experience.
• Support clinical credentialing and medical record review of Network Practitioners as needed.
• Collaborate with senior management and various departments regarding clinical program, policies, and protocol development and implementation.
• Review files in regulatory, accreditation, health plan, and medical group audits as required.
• Conduct outreach calls as assigned.
• Participate in Clinical Quality Administration and Clinical Quality Evaluation workgroups.
• Promote a productive team environment.
• Participate in clinical article review activities as assigned.
• Provide interdepartmental Support to Medical Necessity Administration department as necessary for performance of assigned tasks.
• Work independently, receiving minimal guidance and supervision.

Qualifications

Core Competencies

Mobility

Primarily sedentary, able to sit for long periods of time, able to travel by automobile and air.

Physical Requirements

Ability to speak, see and hear other personnel and / or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

Environmental Conditions

Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity / Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.

Please view Equal Employment Opportunity Posters provided by OFCCP here .

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

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