Utilization Reviewer - Remote Job For Physical and Occupational Therapists

remote jobs utilization review Oct 19, 2021
Utilization Reviewer Job Resource

Utilization Reviewer - Remote Job For Physical and Occupational Therapists

If you are looking for a job that doesn't require extra education, pays similar to clinical salary, and where you can work full time at home - then we recommend you read this article on becoming a Utilization Reviewer (also known as Clinical or Therapist Reviewer. 

What is a Utilization Reviewer?

A Therapist Reviewer (it has several titles, you can look up utilization management or clinical reviewer as well)  performs medical record reviews of therapist or therapist assistants notes to make sure that they adhere to proper billing and documentation standards. 

What does that mean? You are essentially using your therapy background, critical thinking, decision making, and evidenced based practice skills to determine if the patient is still medically appropriate for the skilled care that was provided in the notes you are reviewing.  

We'll go into the exact tasks you'll do in a the next few paragraphs.  But quite note, we get asked if therapists feel pressure from their employers - and I can tell you that not one therapist has told us that they do. While this job is not always fun or easy, our students have not reported feeling pressured into doing anything unjust or unethical. You also have a team with you helping to review these notes too - so don't feel like all the pressure is on your shoulders. 

 

 

What do I need to be able to work from home as a Utilization Reviewer?

  1.  Have a office or room that is quite with decent lighting
  2.  Have a laptop or desktop
  3. I would also recommend a web camera and small extra light 
  4. Working cell phone or landline
The nice thing is that most companies will supply you with most of the equipment to fulfil your remote role as well as some ergonomic equipment too! 
 

What is a typical day for a Utilization Reviewer? What are typical responsibilities or tasks you would perform as a Utilization Reviewer?

This is typically a full time role that is 100% remote and is usually 9am-5pm or a similar time frame. 

Also one thing that's awesome about these roles is that they train you! Your first month or so is just training - and it's paid training! So don't feel intimated if you do not have any knowledge in utilization review or care coordination. 

There are several duties that you may perform, some may be daily tasks, some may be monthly tasks, or some may be weekly tasks. It also may vary based on the particular patient care you receive as well. But here are some main tasks that a therapist reviewer may perform:
  • Conduct daily medical documentation reviews

  • Document your findings and create an summary report to be provided to the appropriate team member or department
  • Research evidenced based guidelines if needed to better understand your patient case
  • You may need to gather additional data from the facility or therapist provider
  • You may determine approval or recommend a referral to a physician to ensure your decision is appropriate
  • Coordinate with the clinical team
  • Attend additional trainings or meetings as needed

     

     
These are the lists of roles mentioned on Anthem's website as of 2021. This may change depending on when you read this article. 
 

Who can apply to be a Utilization Reviewer?

  • Physical Therapists
  • Physical Therapist Assistants
  • Occupational Therapists
  • Occupational Therapist Assistants
  • Speech Therapists

What else do I need to qualify?

  • Active, unrestricted license
  • Usually several years of clinical experience required - they say this but we've had new grads, recent grads get hired so still apply!
  •  Authorization, Case Management experience preferred - they say this but similar to above, we've had new grads and recent grads get hired and those with NO case management experience so still apply!
  • Acute care, rehab, outpatient or skilled nursing facility experience is helpful
  • They want team players, organized people, critical thinkers, good communicators and self motivators as you'll be working alone at home
  • Previous PTA/OTA supervision is also a plus
  • Experience performing team meetings with a variety of staff including physicians is a plus
  • Strong Medicare knowledge with ICD 10 and InterQual experience or knowledge being helpful

How do I know if I would like working as a Utilization Reviewer?

At Alternative Healthcare Careers, I love talking about remote positions - it's my passion! But there are quite a few positions out there, and it can be hard to know what one would be best for each person. Hopefully, in this section, I can help you know if you would like a job as Utilization Reviewer. 

What you first need to know is that there are several very similar roles that fit the features of remote, full time, similar clinical salary, and no extra education required - these include:

Each one is a little different in your role, in how much time you spend communicating (if any time) with patients, families or therapists, and the interactions you may have with a facility. 

Here are the pro's about being a Utilization Reviewer:

  • It's 100% remote
  • It's a full time employee position with great benefits
  • It has upward mobility - yes I said it!
  • Flexibility. This role, as well as the other 2 I mentioned above, after one year of working with naviHealth, you can actually move into other roles if you want to try those instead. 
  • You can go at your pace and basically manage yourself

 

Here are some con's about being a Utilization Reviewer:

  • It is very sedentary. You are essentially at your computer 100% of the time.  So if you are looking for more activity, then this may not be the right role. 
  • You have to be organized and a self starter
  • You may get lonely as you are doing just computer tasks
  • You are reading medical notes and documentation - so if you do not like reading, then this may not be a good fit. 

How to Choose if Utilization Reviewer is the right for you (Summary):

Essentially, if you are good working solo, want no or very little people interaction, and like a quite environment, then this can be a great role for you! 

Pre-Service Coordinator has a very similar feel and pros/cons, but it has just a little more interaction with people. You can read more about this role here: https://www.alternativehealthcarecareers.com/blog/pre-service-coordinator.

Now if you want more patient and family interaction and a slightly less sedentary role, then I think a care coordinator role would be a better fit for you and you can read more about what is a care coordinator here:https://www.alternativehealthcarecareers.com/blog/care-coordinator

 

Become a Utilization Reviewer, Care Coordinator or Pre-Service Coordinator Today! 

We really hope this article has helped you understand if this is the right fit for you! We encourage you to check out those other positions too and if you want to take the leap - we do have a complete course that includes CEU credits, resume review and edit, over 6 hours of step by step videos, interview questions and answers, and resume templates and samples for all professions and roles, monthly job emails and constant support if you have any questions. We've had now over 300 students with a high job success rate! 

You can learn more about our program here: https://alternativehealthcarecareers.com/courses/becomeautilizationreviewer 

 

Want to get hired as Utilization Reviewer?

Check out our amazing program that has helped over 400 students! We teach you how to finally get a position within Utilization Management (including appeals & denials, pre service care coordinator, skilled inpatient care coordinator and more)

Check Out Our Utilization Review Course Here

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