POSITION SUMMARY
eviCore Healthcare is seeking a Clinical Reviewer Physical Therapist to join our musculoskeletal (MSK) division, supporting our specialized therapy programs. This includes but is not limited to eviCore’s utilization management and corePath programs. As a Clinical Reviewer Physical Therapist, you will interact with members to promote better outcomes for acute and chronic musculoskeletal conditions. Through telephonic communication you will be responsible to offer support and education to assist members navigating their MSK journey. The Clinical Reviewer is responsible to help educate the member on their condition, available conservative care options and treating provider types. Additionally, they can assist members with accessing pertinent educational material they can use for informed discussion with their treating providers, as well as refer members into programs available by their health plan.

ESSENTIAL FUNCTIONS

Develops and maintains knowledge of MSK trends, including but not limited to conditions, treatments and conservative care options available in the market.

Performs Musculoskeletal Program specific duties assigned by a supervisor.

Provides the member support, reassurance, and education on their diagnosis.

Provides reference material and education related to conservative care, for discussion with their provider.

Empowers members to conduct and participate in discussions with their treating provider(s) to assist them in making informed and educated health care decisions.

Empathetically communicates with the member during discussion(s).

Performs Utilization Management specific duties assigned by a supervisor.

Reviews clinical information submitted by providers to appropriate criteria and standards and makes decision to issue a review determination or to refer a physician review if criteria is not met.

Promotes cost effective utilization and quality patient outcomes and may partner with providers to determine best solutions.

Develops and maintains knowledge of provider organization review procedures.

Assures compliance with accrediting agencies and federal regulations, as well as company and program specific duties.

Completes all required training, such as company and program specific.

Performs other duties as needed to support the musculoskeletal division and supporting programs.

MINIMUM EXPERIENCE
• Minimum of five (5) years of clinical experience.
• Must possess valid Physical Therapy license in state of residence.
• Tasks involve a degree of forward planning and anticipation needs/issues

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 28 - 47 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.