Advanced Therapy Services Reviewer (Physical Therapist)

The Advanced Therapy Services Reviewer (Physical Therapist) is responsible for conducting timely and quality clinical case evaluations to determine the medical necessity of therapy service requests, ensuring prompt, consistent, and compliant decision-making. Location: Virtual -  This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. How you will make an impact: Conduct clinical case reviews to assess the medical necessity of therapy services (physical therapy). Support medical management staff to ensure consistent, timely decisions for members and providers. Lead peer-to-peer calls with therapist providers to gather clinical information and make determinations. Render adverse determinations for specific clients when appropriate. Document findings, develop analyses, and submit reports in compliance with regulatory standards. Apply company medical policies and guidelines consistently when making decisions. Escalate cases requiring Medical Director review or policy interpretation. Participate in departmental projects and initiatives. Maintain established quality and productivity standards.

Requires BA/BS in physical therapy, occupational therapy, or speech language pathology physical therapy and minimum of 1-year clinical experience; or any combination of education and experience, which would provide an equivalent background. Current valid, active and unrestricted license as a physical therapist, occupational therapist, or speech language pathologist in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: Master’s degree or higher in physical therapy strongly preferred. Job Level: Non-Management Non-Exempt Workshift: Job Family: MED > Licensed/Certified Allied Health Professional Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several