Occupational Therapist – Utilization Review
Location: Remote
Licensure: Current, active, and unrestricted Occupational Therapy license issued by the Arkansas State Medical Board.
Job Summary
Astyra is seeking a licensed Occupational Therapist (OT) to support Utilization Review and Management functions. The OT will use clinical expertise to assess medical necessity, appropriateness of care, and compliance with contractual and regulatory standards. This role involves detailed review and abstraction of medical record data to support utilization management determinations.
Key Responsibilities
- Review and interpret patient medical records, applying clinical knowledge to assess medical necessity and appropriateness of occupational therapy services.
- Abstract and document review-related data accurately and completely from medical records and supporting documentation in accordance with internal and client standards.
- Compare clinical documentation against established criteria and policies to determine whether services meet medical necessity requirements.
- Determine approvals or initiate referrals to consulting physicians when criteria are not met, ensuring detailed and compliant documentation of all determinations.
- Maintain accurate and timely case records, ensuring data integrity and adherence to productivity and quality standards.
- Collaborate effectively with internal teams and external providers to ensure efficient communication and case resolution.
- Identify process improvement opportunities in review workflows and quality assurance practices.
- Maintain patient confidentiality and adhere strictly to HIPAA Privacy and Security Rules.
- Participate in cross-training to ensure flexibility and coverage within the utilization management team.
Experience & Qualifications
- Licensure: Current, active, and unrestricted Occupational Therapy license issued by the Arkansas State Medical Board.
- Education: Master’s degree or higher in Occupational Therapy from an accredited program.
- Minimum 2 years of clinical experience in an occupational therapy setting.
- Minimum 1 year of experience supporting individuals with developmental disabilities preferred.
- Prior experience in Utilization Review/Management or clinical documentation review.
- Excellent analytical, writing, and decision-making skills.