Occupational Therapist (OT) – Outpatient Utilization Review 26-02140
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Job Location:
Albany, GA - USA
Monthly Salary:
Not Disclosed
Posted on:
2 days ago
Vacancies:
1 Vacancy
Job Summary
Occupational Therapist (OT) Outpatient / Utilization Review
Profession: Therapy / Rehabilitation
Specialty: Outpatient Occupational Therapy
Shift: Days 5x8 (8:00 AM 5:00 PM)
Duration: 26 Weeks
Location: AlbanyNew York
Important Note
This position is part of a formal bid/RFQ process.
Selection timelines may be extended due to state review procedures.
Position Overview
Seeking a licensed Occupational Therapist (OT) to support clinical review and prior authorization functions within a Medicaid-regulated environment.
This role focuses on reviewing Durable Medical Equipment (DME) Prosthetics Orthotics and Supply (DMEPOS) requests to determine medical necessity and regulatory compliance. The position requires strong clinical judgment documentation review experience and familiarity with state and federal healthcare regulations.
Key Responsibilities
Conduct comprehensive reviews of DMEPOS prior approval requests
Determine medical necessity in accordance with Medicaid program guidelines and state regulations
Apply professional clinical judgment to ensure requested services meet individual medical needs
Participate in the Fair Hearing process by:
Providing written supporting documentation
Representing the department via telephone as needed
Review medical records and proposed treatment plans
Utilize national procedure and diagnosis coding standards
Identify inappropriate service combinations and support fraud prevention efforts
Communicate with physicians stakeholders and Medicaid members via written and telephonic correspondence
Maintain accurate documentation and regulatory compliance
Required Qualifications
Current Occupational Therapy license/certification
Excellent written and verbal communication skills
Experience with:
Prior authorization review of medical supplies/equipment/services
ORReviewing medical records and treatment plans for medical necessity
Experience with Microsoft Office
Proficiency in standard office technology
Ability to work collaboratively in a team environment
Strong analytical and decision-making skills
For more details reach at or Call / Text at -EXT 4807.
Required Experience:
IC
Key Skills
- Body Mechanics
- Early Intervention
- Acute Care
- Communication skills
- HIPAA
- Autism Experience
- Computer Literacy
- Pediatrics Experience
- Home Care
- Heavy Lifting
- Patient Service Experience
- Medicare
