Clinical Analyst Level I

Position Summary

The primary role of the Clinical Analyst position is to assist in the clinical processes associated with clinical oversight of worker’s compensation cases. Focus is on Certified Hand Therapy, Occupational Therapy, Pool Therapy, Physical Therapy, Word Conditioning, Work Hardening, and TeleServices programs. The Analyst has the potential to participate in the collection of non-clinical and clinical data, collection of necessary documentation for clinical review, and complete clinical reviews, which requires evaluation and interpretation of clinical information. When assisting in Teleservices, the Analyst will be involved with activities, which allows the injured worker to move through the program from scheduling for the initial visit through discharge from services. All areas the Clinical Analyst participates in may require calls to US-based MD/therapy offices with discussion with the front office staff and/or the treating therapist. Calls to Patients may occur in areas of the TeleServices program.

Primary Duties & Responsibilities

Clinical Oversight: 

Confirming attendance of initial evaluation (IE) and receipt of IE Report 

Reviews documentation and updates cases with accurate clinical information, including but not limited to ICD codes, Date of Surgery, Clinical Guidelines, ROM/Strength measurements 

Initiates review for requested service upon referral o Review types include Continued Authorization and Internal Clinical Reviews 

Obtains, compiles, proofs and processes information received from providers/adjusters to aid in the final determination of a clinical reviewer. 

Reviews all assigned cases to provide efficient, cost-effective and quality utilization review services. 

Teleservices: 

Opens new Telerehab cases in the system and participates in scheduling injured workers for Telerehab 

Manages phone calls coming into department through the Telerehab Queue (internal and external calls) 

Monitors and handles Telerehab inbox including email, voicemail and fax communications for Teleservices team 

Participates in processing continued authorization for Telerehab cases including communication with physician offices and adjusters 

Handles other Teleservices duties as assigned

Overall Duties:

Documents all pertinent clinical patient/case information and actions into the case notes. 

Complies with all established policies and procedures 

Assists manager and team in quality improvement projects to provide instructive feedback to practitioners within scope 

Attends meetings and trainings. 

Meets quality management standards. 

Performs activities within the scope of professional licensure. 

Completes other duties and projects as assigned.

Qualifications 

Must hold a current Philippines Physical Therapy License 

Experience: 2-3 years of outpatient hospital clinic setting strongly preferred 

Knowledgeable of current physical medicine treatments 

Excellent verbal and written communication skills 

Organizational skills, prioritization, problem-solving and decision making skills are required 

Ability to multi-task in a fast paced environment 

Must be computer literate and be able to use the keyboard accurately. Experience with Microsoft Office and Zoom app are desired. 

Strong analytical and interpersonal skills are also required. 

Not required, but desired: current US Physical Therapy license and/or Doctor of Physical Therapy degree 

Experience in utilization review, case management, quality improvement and/or managed care is desired