Outpatient Occupational Therapist – Medicaid Prior Authorization Reviewer
Albany, NY
Access Healthcare
5x8 hrs, Days

Job Opportunity: OT Outpatient (Therapy/Rehabilitation)

Location: Albany, New York
Employment Type: Travel/Contract
Contract Length: 26 weeks

Position Overview

• Conduct comprehensive review of Durable Medical Equipment, Prosthetics, Orthotics, and Supply requests for Medicaid recipients.
• Determine if services fall within Medicaid Program coverage and NYS regulations.
• Use professional clinical knowledge and judgment to ensure requested items meet individual medical needs.
• Participate in the Fair Hearing process by providing written evidence and representing the Medicaid Prior Approval Department via telephone.
• Knowledgeable of NYCRR Title 10 and 18 regulations.
• Utilize national standards for procedure and diagnosis coding.
• Review combinations of medical services to identify methods to prevent fraud and abuse.
• Collaborate closely with physicians, outside stakeholders, and Medicaid members through written and telephonic communication.

Required Qualifications

• Valid Occupational Therapist license in New York.
• Minimum of 1 year of Occupational Therapist experience, including experience within the last year.
• Experience in prior approval of medical supplies, equipment, or services, or experience in examination of medical records, documentation, and proposed treatment plans for medical necessity.

Required Certifications

• ACLS (Advanced Cardiac Life Support) – American Heart Association or American Red Cross.
• BLS (Basic Life Support) – American Heart Association or American Red Cross.
• PALS (Pediatric Advanced Life Support) – American Heart Association or American Red Cross.

Required Competencies and Exams

• Competency Exam required for all candidates.

Background and Health Requirements

• Background check within 1 year for the last 7 years of locations lived/worked/schooled, including SS Trace, County searches, Nationwide, and Sex Offender registry.
• Criminal Background Check Fingerprinting required (completed onsite except for certain facilities).
• Physical exam within 1 year of start (no annual renewal required).
• Negative TB test or chest X-ray (Qgold, Tspot, or 2-step PPD) within 12 months prior to start.
• Annual TB Questionnaire completion required.
• Vaccination documentation or titers for:

  • Rubeola (Measles)
  • Mumps
  • Rubella
  • Hepatitis B (vaccination, titers, or declination)
  • Varicella
• Drug testing (9 panel) within 1 year of start (instant tests acceptable).
• Seasonal flu vaccination or declination for 2025-26.
• COVID-19 vaccine booster preferred but not required.

Additional Requirements

• Two professional references required.
• Medicaid enrollment documentation required for New York Medicaid providers (specific instructions apply).

Experience

• Specialty: Therapy/Rehabilitation (Occupational Therapy)
• Years of experience: Minimum 1 year of Occupational Therapy experience, including recent experience within the last year.
• Prior travel experience: Not required.

Note: This is a state-run contract position subject to a bid process with a slow timeline for candidate selection.