Manager, Specialty Therapy & Rehabilitation Services

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Applicants for this role have the flexibility to work remotely within the continental United States.

Highly preferred: Clinical experience with Durable Medical Equipment (DME).

Schedule: The work schedule includes holiday coverage

• Manage clinical services including oversight of clinical policies and procedures and day-to-day operation
• Oversee the provider outreach and training activities pre and post implementation
• Ensure compliance with established initial and concurrent review, referral, and authorization policies, procedures and processes
• Ensure all programs and clinical operations are in full compliance with state and federal regulations, including HIPAA
• Ensure payer contract clinical deliverables are met
• Monitor the effectiveness of existing procedures and outreach/intervention efforts and ensure full compliance with physical, occupational, speech, and home health scope of practice state guidelines
• Analyze data, monitor trends and recommend potential quality improvement opportunities including provider issues, service gaps, member needs
• Ensure accurate and timely reporting to health plan partners on authorizations, denials, appeals, provider outreach, call center metrics, and utilization trends to include analytics and interventions
• Performs other duties as assigned
• Complies with all policies and standards