• 20 Nov 2014 3:52 PM | Lindsay Larkin (Administrator)

    Create a healthier world, one person at a time.

    Maximize your talents in an innovative setting. Leverage your healthcare and business skills to improve the lives of others. Make the world a healthier place, with Healthways. As the largest independent global provider of well-being solutions, we use the science of behavior change to produce positive results for our clients. Join us, and see the big difference you can make.

    Part-Time, Flexible Schedule: 20-30 hours/week

    Reporting to the Senior Medical Director for PT/OT Services, you will provide utilization review and management services, as well as general clinical support to the Healthways Physical Medicine Utilization Management Program. Additional responsibilities include specific UR/UM services encompassing pre- and post-service medical necessity reviews, reconsideration, and appeals. You will also have the opportunity to:

    • Perform assigned pre-service clinical peer reviews.
    • Perform post-service clinical peer reviews of out-of-network claims.
    • Conduct peer-to-peer discussions, reconsideration, and appeal reviews.
    • Participate in group reviewer meetings.
    • Take part in the quarterly Inter-Rater Reliability Assessment process.
    • Complete the annual performance review process.
    • Maintain compliance with organizational and state/federal regulatory requirements.

    Job Requirements


    • Current, active, unrestricted professional license to practice as an occupational therapist in at least one state within the United States
    • Bachelor's, Master's, or Doctorate degree in occupational therapy
    • Five or more years of experience in clinical practice
    • Strong business and organizational skills
    • Ability to read, analyze, and interpret documents, including company policies and procedures, and medical records
    • Strong leadership, analytical/problem-solving, and critical-thinking skills
    • Ability to apply clinical criteria and medical-necessity guidelines, and interpret instructions furnished in various formats
    • PC proficiency, including MS Office suite and UR/UM applications


    • Additional credentials or advanced clinical training in occupational therapy or certification in UR/UM
    • Specialized training in occupational therapy and rehabilitation
    • Experience in utilization review, utilization management, and quality assurance and/or health plan experience

    Healthways offers the competitive pay, fitness programs, and opportunities for professional, community, and personal development you would expect of an industry leader.

    Apply Today.
    Please send resumes to

    You may also apply online at

    We are proud to be an EEO/AA employer M/F/D/V.

2415-B Westwood Avenue | Richmond | VA | 23230
T: (804) 523-2911
F: (804) 288-3551

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