Reviewer – Therapy Services

Elevance Health

. Review medical records to determine whether requests for physical therapy, occupational therapy, and/or speech-language pathology services were medically necessary and filed appropriately .

Posted 10/7/2026full-timeUnited StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in reviewing medical records for therapy services, ensuring compliance with government regulations, and making care approval decisions. Possesses strong analytical, problem-solving, and communication skills essential for effective collaboration and documentation.

Highest-signal resume keywords

Clinical ExperienceCurrent Active Unrestricted LicenseUtilization ManagementPrior Authorization ExperienceAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Record ReviewCare Approval Decision MakingDocumentation and ReportingData Research and AnalysisQuality and Productivity Standards

Soft Skills

Oral Communication SkillsWritten Communication SkillsInterpersonal Communication SkillsProblem-Solving SkillsFacilitation Skills

Certifications & Qualifications

Physical Therapist Assistant LicenseOccupational Therapist Assistant LicenseSpeech Language Pathologist Assistant License

Industry Keywords

Utilization ManagementSkilled NursingMedicare Advantage ReviewPeer Clinical ReviewGovernment Regulations

About the role

Key responsibilities & impact

Review medical records to determine whether requests for physical therapy, occupational therapy, and/or speech-language pathology services were medically necessary and filed appropriately
Follow system guidelines to make care approval decisions for patients
Process system-generated authorization decisions while meeting contract requirements, operational processes, and unit goals
Document findings, develop analyses, and submit reports to appropriate departments in accordance with government regulations and requirements
Research and obtain additional data
Consult with clinical reviewers and medical directors when necessary
Act as a resource for internal and external customers
Participate in intradepartmental teams, projects, and initiatives as needed
Maintain quality and productivity standards
Complete reviews within required timeframes

Requirements

What you’ll need

Graduate of a college level program in physical therapy, occupational therapy, or speech language pathology, or an accredited two-year program for a Physical Therapist Assistant, Occupational Therapist Assistant, or Speech Language Pathologist Assistant, and minimum of 1 year of clinical experience; or equivalent combination of education and experience
Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state required
Certification and/or licensure appropriate to field of specialty required
For URAC accredited areas: current, active, unrestricted license in occupational, speech, or physical therapy to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States
For URAC accredited areas: current, active, unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state or territory of the United States
Unless expressly allowed by state or federal law or regulation, located in a state or territory of the United States when conducting a peer clinical review
Strong oral, written and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills
Utilization Management and/or Skilled Nursing experience preferred
Prior Authorization and Ongoing Continued Care experience preferred
Medicare Advantage Review experience preferred
Tuesday–Saturday or Sunday–Thursday, 8:00 AM–5:00 PM schedule

Benefits

Comp & perks

Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) + match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual full-time work, except required in-person training sessions
Maximum flexibility and autonomy