Clinical Review Specialist - Part Time

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

Be part of a team that makes a real difference.

You Must Reside in the Eastern or Central Time Zone

This is a Part Time Position at 20 hours a Week

The Clinical Review Specialist is a vital member of the Clinical Oversight Team within Apricus. This role involves reviewing physical therapy services for injured workers to ensure high-quality care and appropriate treatment. You will provide clients with updated clinical summaries and recommendations regarding continuation or discontinuation of therapy services. This position is available as a remote work opportunity with expectations for maintaining confidentiality of company and customer information.

Key Responsibilities:

• Conduct reviews of physical or occupational therapy evaluation and treatment documentation
• Perform Peer-to-Peer communication with treating or supervising PTs and OTs via phone and/or email to review therapy care plans for injured workers covered by Workers Compensation claims.
• Utilize state and national disability guidelines to assess duration of care and provide clinical recommendations for ongoing therapy or discharge readiness. 
• Prepare detailed reports and clinical summaries with written support of recommendations for clients
• Maintain communication with nurse case managers and other claim stakeholders as needed
• Collaborate with operations and clinical admin staff to ensure appropriate authorization
• Perform provider follow up regarding authorization and/or clinical recommendations

Provides clinical process assistance for various tasks such as process verification, clinical reviewer assistance, establishing and applying clinical review standards, and providing ongoing assessment of medical necessity and appropriateness, etc.. At the direction of the Clinical Management team, the associate will ensure that each review is carried out in compliance with any accreditation group/s standards (i.e. URAC), all applicable laws and regulations, and corporate policies. The role requires a healthcare background and current active licensure in the respective area to properly interpret the clinical information, clinical guidelines, standards, and jurisdictional rules and regulations in order to make correct recommendations to both non-clinical and clinical staff. The scope of work and specific duties are defined by the Clinical Management team. Licensed healthcare professional in the respective area of focus required (e.g. DC, RN, PT, OT, etc.).

Required Qualifications

• Degree in Physical or Occupational Therapy with active license as Physical/ Occupational Therapist or Physical/ Occupational Therapist Assistant in the United States.
• Experience 3+ years in outpatient therapy setting
• Exceptional communication skills, both written and verbal.
• Ability to provide comprehensive review reports for clients
• Demonstrate ability to meet metrics for reviews case load
• Excellent organizational skills with ability to prioritize work effectively
• Proficiency with company software and equipment

Preferred Qualifications:

• Experience in Workers Compensation Industry
• Knowledge of industry standard treatment guidelines
• Experience in performing quality assessments and/or clinical chart reviews

We’re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $38.00 - $40.00 hourly, and will be based on a number of additional factors including skills, experience, and education.  

The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.  

Don’t meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.