Physical Therapist (Remote - Must Reside In The Alabama)

Keystone Peer Review Organization, Inc. Birmingham , AL 35224

Posted 2 weeks ago

Physical Therapist (Remote - Must reside in the state of Alabama)

  • Are you an experienced Physical Therapist looking for a new challenge?
  • Do you value care management and quality improvement?
  • Are you motivated, energetic, and excited to become part of the Kepro team?

If so, you might be our next new team member!

Who we need:

In this part-time or full-time position, the physical therapist will perform utilization reviews on our Alabama Utilization Management contract. The Physical Therapist will utilize clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking and decision-making skills to determine medical appropriateness, while maintaining production goals and QA standards. This person will also ensure day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards.

Why us?

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.

Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

What youll do:

  • Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the medical record documentation supports the need for services.
  • Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.
  • Abstracts review related data/information accurately and timely on appropriate review tool by the appropriate means. Accurate and timely submission of all administrative and review related documents to appropriate parties.
  • Performs ongoing reassessment of review process to offer opportunities for improvement and/or change.
  • Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process.
  • Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.
  • Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.
  • Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following Kepro policies, procedures and guidelines.
  • Actively cross-trains to perform duties of other contracts within the Kepro network to provide a flexible workforce to meet client/consumer needs.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

What youll need:

Required Qualifications

  • Active unrestricted Physical Therapy license with the Alabama Board of Physical Therapy and Board of Medical Examiners (if applicable).
  • Must reside in the state of Alabama
  • May not hold a concurrent working relationship with a Medicaid-enrolled provider while working on this contract.
  • Vast Knowledge of Medicare & Medicaid wheelchair policy
  • Must be available to work from 9A-4PM and may not hold a concurrent working relationship with a Medicaid-enrolled provider.

Knowledge, Skills, Abilities

  • Knowledge of InterQual criteria strongly preferred.
  • Knowledge of current NCQA/URAC standards strongly preferred.
  • Medical record abstracting skills required.
  • Knowledge of the organization of medical records, medical terminology, and disease process required.
  • Strong clinical assessment and critical thinking skills required.
  • Excellent verbal and written communication skills required.
  • Ability to work in a team environment.
  • Flexibility and strong organizational skills needed.
  • Must be proficient in Microsoft Office and internet/web navigation.

Experience

  • Minimum two years of clinical experience in physical therapy/rehab environment required.
  • Previous utilization management experience highly preferred.

Thank You!

We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Kepro Talent Acquisition Team

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

EOE AA M/F/Vet/Disability

Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Educator Diabetes North Alabama Alabama

Novo Nordisk

Posted 6 days ago

VIEW JOBS 9/22/2022 12:00:00 AM 2022-12-21T00:00 <p>About the Department</p><p>The Diabetes Sales Team leads the US sales efforts for Novo Nordisk's robust cardiometabolic product portfolio, which includes world class therapies for the treatment of diabetes, obesity, and the reduction of adverse cardiovascular events. As part of the team, you will have frontline exposure to our portfolio vision, business strategies, and critical market insights that drive our business forward. You will drive the NNI portfolio strategy in tandem with our marketing team, and balance performance with compassion to ensure that the latest therapies and products reach the people who need them most.</p><p>At Novo Nordisk, we are the world leader in diabetes care and a major player in defeating other serious chronic conditions such as obesity, growth hormone-related disorders and rare bleeding disorders. We use our skills, dedication and ambition to help people with diabetes and other chronic or rare diseases. We are looking for individuals who want to do the same. In exchange, we offer the chance to be part of a truly global workplace, where passion and engagement are met with opportunities for professional and personal development. Are you ready to realize your potential?</p><p>The Position</p><p>Responsible for working with health system accounts and networks to execute the Diabetes Education Program strategy. Interacting with health system key opinion leaders (KOLs), providers, quality, care coordinators, advanced practice providers, and the like to identify their poorly controlled diabetes populations and support their efforts to deliver better care through diabetes education and training following ADA Standards of Care and relevant treatment guidelines. This position will report through commercial health system leadership and is part of the account teams focused on establishing Novo Nordisk as the leader in diabetes care and increasing the demand for the NNI diabetes portfolio of products.</p><p>Relationships</p><p>Externally, the Diabetes Educator maintains relationships with physicians, advanced practice providers, pharmacists, nurses, patients and other key personnel within targeted health system accounts. Additionally, the diabetes educator will interact with key health system departments including: quality, care management, population health, diabetes treatment centres, and other key departments focused on improving diabetes management across the system population. Internally, the Diabetes Educator reports to the Health Systems Diabetes Educator Manager (HSDEM). The Diabetes Educator primarily aligns and liaises with the Health System Account Manager (HSAM) and/or other internal key health system account management as part of NNIs coordinated approach to health system engagement. Other key internal stakeholders include: sales, market access, marketing, and medical personnel. This position is part of Novo Nordisk Inc (NNIs) commercial organization and is responsible for key commercial performance and deliverables.</p><p>Essential Functions</p><ul><li><p>Work with health systems accounts to identify &quot;at risk&quot; patient populations and utilize diabetes education following the ADA Standards of Care and other relevant treatment guidelines to appropriately recommend the most appropriate Novo Nordisk's products and solutions approved for the customer's needs</p></li><li><p>Leverage PHM priorities/value-based models to change health system and provider behavior</p></li><li><p>Maximizes opportunities with NNI brand strategies, pull-through and support programs to improve diabetes care</p></li><li><p>Coordinate closely with NNI's health system account teams to establish Novo Nordisk as the preferred diabetes care partner</p></li><li><p>Localize approach and provide education and support based on health system priorities, opportunities and needs</p></li><li><p>Coordinate with sales to competitively differentiate NNI, drive portfolio volume and improve patient outcomes</p></li><li><p>Develops productive relationships with key decision makers responsible for the direct management and care for the &quot;at risk&quot; diabetes patient population (E.g., providers, care coordinators, quality, population health, clinical pharmacy)</p></li><li><p>Educate providers on strategies to improve NNI diabetes medication adherence and collaborate with the health system account teams to leverage opportunities to train health care professionals on the proper use, handling and administration of Novo Nordisk products</p></li><li><p>Delivers education and provider support tactics that align to the internal health system account team plans and key business deliverables</p></li><li><p>Implement diabetes curriculum and direct overall provider/staff training and education liaising directly with the NNI account teams</p></li><li><p>Provide enhanced awareness of the Novo Nordisk diabetes portfolio and patient support programs</p></li><li><p>Serves as an NNI ambassador and trusted advisor in diabetes education for health system accounts</p></li><li><p>Coordinate on the delivery of innovative programs and solutions within health care systems</p></li><li><p>Adapts educational initiatives and tactics to stay current with the market trends and opportunities</p></li><li><p>Implements customized educational programs based on customer needs</p></li><li><p>Communicate and share actionable field insights and customer opportunities to field leadership</p></li><li><p>Demonstrates openness to coaching and direction and business agility</p></li></ul><p>Physical Requirements</p><p>75-90% overnight travel required; Driver must maintain a valid driver's license. Must be in good standing by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records.</p><p>Qualifications</p><ul><li><p>A Bachelor's or equivalent degree is required, and/or Pharm D</p></li><li><p>3+ years of relevant diabetes clinical experience preferred</p></li><li><p>Registered Nurse, Registered Dietitian, Physician Assistant, Nurse Practitioner, Pharmacist, or other relevant certifications that are Healthcare related are required</p></li><li><p>A Certified Diabetes Educator (CDE) or Certified Diabetes Care and Education Specialist (CDCES) is preferred</p></li><li><p>Complete understanding and application of principles, practices, and standards in diabetes care</p></li><li><p>Current knowledge of health care trends and &quot;at risk&quot; population management principles</p></li><li><p>Deeper understanding of Advanced Alternative Payment Models and other quality incentives that are focused on value-based care and pay for performance</p></li><li><p>Current health system account experience a plus</p></li><li><p>Cardiovascular experience a plus</p></li><li><p>Strategic thinker with proven ability to drive results</p></li><li><p>Ability to work independently in a field-based role required</p></li><li><p>Bilingual (i.e. fluency in Spanish and English) may be required for some areas of the country</p></li><li><p>Excellent verbal/written communication skills are required</p></li><li><p>Intermediate computer skills required (Windows, Word, Excel)</p></li><li><p>Prior computer experience using sales data/call reporting software preferred</p></li></ul><p>We commit to an inclusive recruitment process and equality of opportunity for all our job applicants.</p><p>At Novo Nordisk we recognize that it is no longer good enough to aspire to be the best company in the world. We need to aspire to be the best company for the world and we know that this is only possible with talented employees with diverse perspectives, backgrounds and cultures. We are therefore committed to creating an inclusive culture that celebrates the diversity of our employees, the patients we serve and communities we operate in. Together, we're life changing.</p><p>Novo Nordisk is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, protected veteran status or any other characteristic protected by local, state or federal laws, rules or regulations.</p><p>Novo Nordisk requires all new hires to be fully vaccinated against COVID-19 prior to the first date of employment. As required by applicable law, Novo Nordisk will consider requests for reasonable accommodation.</p><p>If you are interested in applying to Novo Nordisk and need special assistance or an accommodation to apply, please call us at 1-855-411-5290. This contact is for accommodation requests only and cannot be used to inquire about the status of applications.</p><br> Novo Nordisk Birmingham AL

Physical Therapist (Remote - Must Reside In The Alabama)

Keystone Peer Review Organization, Inc.