Job Summary

• The Clinical Peer Reviewer (Phyiscal Therapy) Utilization Management (UM) plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations.
• This role ensures appropriate, evidence-based utilization of Physical Therapy (PT), services across lines of business while maintaining regulatory compliance and supporting optimal functional outcomes for members.
• Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions.

Matching Summary

Salary

Base: $83,100 - $120,360 (Greater NY Area); $73,400 - $108,160 (Other Locations); Bonus/Equity: Not specified; Benefits: Medical, dental, vision, 401k

Skills & Requirements

Key Requirements

• Masters of Physical Therapy (MSPT)
• Active, unrestricted NYS PT license
• 5 years post-residency clinical practice
• Managed care or utilization management experience
• Knowledge of rehabilitative medicine
• Familiarity with Milliman Care Guidelines (MCG)
• Independent clinical judgement and critical thinking

Work Rights