Utilization Management Speech Specialist

We are searching for a Utilization Management Speech Specialist -- someone who provides precertification of outpatient and home speech therapy services requiring authorization. To perform telephonic and/or concurrent review of speech therapy services. This process includes clinical judgement, utilization management,

application of product benefits, understanding of regulatory requirements, and verification of medical necessity utilizing nationally recognized criteria. In addition, discharge planning and provider education are major components of this process.

Think you got what it takes:

Qualifications:

• Master's degree in Speech-Language Pathology
• CCC-SLP - Cert-Speech Language Pathology from the American Speech-Language-Hearing

Association (ASHA)

• TX-SLP - Texas Speech Language Pathology from the Texas Department of Licensing and Regulation
• 2 years experience in professional speech-language pathology and/or utilization management experience

Responsibilities:

• Assess the treatment plan, clinical information, and medical necessity of all requested services
• Facilitates provider communication and education
• Liaisons with internal and external managed care staff members.
• Assess and refers potential case management cases
• Ongoing assessment for quality indicators and concerns
• Assess and process all denial determination after medical director review