PT/OT Utilization Management Specialist
Houston, TX
PRIDE Health
5x8 hrs
Referral Bonus

Job Opportunity: Utilization Management PT/OT Therapist Specialist

Location: Houston, Texas
Employment Type: Clinical Allied Travel

Job Description

• Provide prior authorization for outpatient and home physical and occupational therapy services requiring authorization.
• Use clinical judgment for utilization management, apply product benefits, understand regulatory requirements, and verify medical necessity using evidence-based criteria.
• Educate providers as part of the process.

Key Responsibilities

• Certify requested services using established criteria within required timeframes.
• Consult with physicians and therapists regarding patient history and current care needs.
• Refer cases that do not meet medical necessity criteria to medical director or designee.
• Enter information timely into systems, assign appropriate length of service, and communicate authorization numbers to providers and members.
• Evaluate benefit coverage and regulatory guidelines relevant to decision making.

Contract Length

• 18 weeks

Required Skills & Experience

• Minimum 5 years of professional physical therapy and/or utilization management experience.
• Experience measuring or testing musculoskeletal, neurological, pulmonary, or cardiovascular function.
• Skilled in rehabilitative treatment aimed at restoring function or preventing disability caused by illness, injury, or birth defect.
• Experience providing treatment, consultative, educational, or advisory services to reduce disability or pain and enable independent skills and activities of daily living.
• Ability to prevent, identify, correct, or alleviate acute or prolonged movement dysfunction or pain of anatomic or physiologic origin.
• Proficient with personal computers, general office equipment, and audio/video equipment.
• Strong verbal and written communication skills.
• Ability to maintain confidentiality of patient information.
• Highly motivated, able to work independently and collaboratively with team members.
• Pediatric experience preferred.
• Prior utilization management (UM) and/or managed care organization (MCO) experience is a plus.

Work Schedule & Environment

• Monday to Friday, 8 AM to 5 PM; overtime required.
• Hybrid work model with onsite requirements for training, team meetings, town halls, and during internet/power outages.

Education & Licensure

• Degree in Physical Therapy OR Occupational Therapy.
• Licensed Physical Therapist or Occupational Therapist issued by the Texas Board of Physical or Occupational Therapy Examiners.