PT Utilization Management Reviewer

Blue Cross Blue Shield of Massachusetts(1 month ago)

HybridFull TimeMedior$84,360 - $103,120Utilization Management

About this role

The Physical Therapy Utilization Management Reviewer evaluates the appropriateness and medical necessity of outpatient rehabilitation and related services, ensuring care aligns with clinical guidelines, company policies, and member benefits. The role works independently and collaboratively within a multidisciplinary clinical team to facilitate efficient, medically appropriate use of care. This position is eligible for a mobile persona with an in-office requirement at the Hingham location twice monthly.

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Required Skills

Utilization Management
Clinical Assessment
Care Coordination
InterQual
Communication
Critical Thinking
Clinical Judgment
IT Systems
Regulatory Compliance

Qualifications

Doctor of Physical Therapy (DPT)
Master’s in Physical Therapy (MSPT)
Bachelor’s in Physical Therapy (BSPT)
Active MA PT License
High School Diploma

About Blue Cross Blue Shield of Massachusetts

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