Senior Clinical Review Specialist 3 in San Diego, California at Mitchell International

Mitchell International
Senior Clinical Review Specialist 3

US--Remote

Job ID: 26-18982
Type: Regular Full-Time
# of Openings: 1
Category: Medical Services & Support
Mitchell International, Inc.

Overview

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.

Responsibilities

Senior Clinical Review Specialist Level 3

The Senior Clinical Review Specialist Level 3 is a clinical leader and subject matter expert within the Clinical Oversight Team at Apricus. This role involves overseeing the review of complex physical therapy services for injured workers to ensure high-quality care and appropriate treatment, with primary responsibility for clinical strategy, policy development, and team management. You will provide strategic clinical guidance, develop clinical standards, and ensure organizational compliance with clinical best practices. This position is available as a remote work opportunity with expectations for maintaining confidentiality of company and customer information.

Key Responsibilities:

• Oversee comprehensive reviews of highly complex, precedent-setting, and atypical 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, including all escalated, disputed, or high-impact cases
• 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
• Provide clinical oversight, quality assurance review, and approval authority for all peer work
• Lead and mentor the entire Clinical Review Specialist team, including Level 1 and Level 2 Senior Specialists
• Develop, implement, and refine clinical review protocols, guidelines, and best practices
• Lead comprehensive quality assurance initiatives, clinical audits, and continuous improvement programs
• Serve as primary escalation point and final authority for complex clinical determinations
• Represent Clinical Oversight Team in cross-functional strategic initiatives and policy development
• Ensure organizational compliance with evolving state and federal clinical standards

Qualifications

Required Qualifications

• Degree in Physical Therapy with active license as Physical Therapist or Physical 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

Salary: