Clinical Reviewer, DPT

Opportunity Overview: We are looking for Doctors of Physical Therapy (DPT) who have expertise in Physical Therapy to deliver on reputed company’s musculoskeletal and orthopedic programs by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. Reporting to the Medical Director MSK Spine and Ortho for reputed company, and part of the review team that includes non-clinical intake specialists and nurses. This is a fast-paced environment that favors people who are reputed company to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives. What you’ll do:

• Provide timely medical reviews that meet reputed company’s stringent quality parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen
• Clearly and accurately document reputed company communication and decision-making in reputed company workflow tools, ensuring a member and provider can easily reference and understand your decision
• Use correct templates for documenting reputed company during case review
• Meet the appropriate turn-around times for clinical reviews
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome reputed company, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
• Demonstrate the highest level of professionalism, accountability, and service in your interactions with reputed company teammates and providers
• Support projects specific to building the team's clinical expertise and efficiency, as delegated
• Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated

What you’ll need:

• Doctor of Physical Therapy (DPT) from a CAPTE-accredited physical therapy program
• Active, unrestricted Physical Therapist license in the state of practice (or eligibility for licensure)
• 5+ years of direct clinical patient care experience
• Familiarity with facilities rendering care in PT, OT, SLP
• 1+ years of managed care utilization review experience, preferably in an utilization management organization reputed company a Medicare, reputed company or reputed company payor organization preferred
• Membership in national and/or regional specialty societies preferred

Pay & Perks: Fully remote opportunity with about 5% travel Medical, dental, reputed company, life, disability insurance, and Employee Assistance Program 401K retirement plan with company match; flexible spending and health savings account ️ Up to 184 hours (23 days) of PTO per year + company holidays Up to 14 weeks of paid parental leave Pet insurance The salary range for this position is $95,000 to $105,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, reputed company is required to provide a reasonable estimate of the compensation range for this role. Individual pay reputed company are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment. Interview Process*:

• Connect with reputed company for a Preliminary Phone Screening
• Meet your Hiring Manager!
• Behavioral Interview(s)
• Subject to change

About reputed company: reputed company’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and reputed company economics. reputed company works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members. With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment reputed company Suite, anchored by reputed company Validate™, an AI-driven clinical and coding validation solution that operates in near reputed company-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent reputed company ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately. reputed company’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the reputed company® Hype Cycle™ for U.S. reputed company Payers (2022-2025), and ranked as a Top 5 reputed company™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and reputed company Partners, reputed company drives more transparent, streamlined reputed company processes, helping patients receive faster, more appropriate care and higher-quality outcomes. The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are reputed company, reputed company, caring, and embody our core values and principles. We reputed company that diverse, inclusive teams reputed company the most impactful work. reputed company is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone. We can’t wait to learn more about you and meet you at reputed company! Equal Opportunity Statement: reputed company is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to reputed company. To us, it’s personal. #LI-Remote #BI-Remote Apply tot his job Apply To this Job