How to Become a Utilization Reviewer as a Rehabilitation Professional

How to Become a Utilization Reviewer as a Rehabilitation Professional

If you are a physical therapist, occupational therapist, speech therapist, occupational therapy assistant, or physical therapist assistant looking for a full time, remote position that pays the same if not better than clinical care – then you need to learn about becoming a Utilization Reviewer.

In this article we’ll teach you what is Utilization Review, help you gain a perspective as to the quality of life you could have by transitioning into this type of position, and give you pointers to help in the hiring process.

What is Utilization Review/Utilization Management?

Each day you’ll review patient documentation to make sure that the patient’s clinical picture and interventions match the billing and number of visits. From this you’ll try to gather more data, and then either approve or deny for insurance reimbursement.

Day in the life of a Utilization Reviewer:

Each day you’ll roll out of your comfy bed at home, walk a couple feet to your computer and get to work!

You’ll be greeted by about 10-15 charts which you’ll have to review and write up a report on that day.  From the feedback we have gathered from interviewing other utilization reviewers, they spend about 30 minutes per case.

Occasionally you’ll have to communicate with your team members or contact the case’s therapist to ask them further questions.

Overall, this is a repetitive job where you will be busy and working hard.

Benefits of a Utilization Review Position: There are a lot of benefits to transitioning from a clinical career to an alternative career such as utilization review or management. Here are the top 5 benefits in my opinion: 

1. This is often a full time and fully remote position! This type of position is like finding a needle in haystack. You have full time positions with benefits, fully remote, and the salary is equal if not better than clinical work.
2. The salary is equal if not better than most clinical positions
3. There is upward movement. In this position, you can become a “team leader” which is similar to saying “manager/supervisor”.
4. They often pay for your additional education and certifications
5. Non physical – there is no lifting, pulling or carrying required.

I also think being “clinical” could be another benefit. We worked really hard and spent a lot of money to get our professional degrees and sometimes it just hurts knowing we left so soon after graduating or that we left at all. At least in this position, your degree doesn’t feel potentially like a waste.

Cons of a Utilization Review Position: I don’t think there are too many negatives to working as a utilization reviewer but here are the top 5 I can think of:

1. Sedentary: You are sitting at your desk all day long. If I did secure a position in this field, I would recommend a standing desk to allow for at least some physical movement.
2. Repetitive: Every day will be essentially very similar. You’ll review 10-15 charts each day and write up the reports. While some may see this as a negative, some may also see this as a pro because you know what you are getting every single day.
3. Disheartening or frustrating:  While the therapists I have spoken with say that their companies do not put pressure on them to deny any reimbursements, some companies perhaps could. And in addition, you may wish you had more time to teach the therapists in your cases better documentation so that their charts could be approved. Saying “no” is never easy, but from what I’ve learned, it is usually pretty obvious and clear cut when denials happen.
4.  Isolated:  You’ll be by yourself all day and often may not speak to any teammate or co-worker if the cases are clear cut. While some may deem this as a con, I would say some would see this as a good thing. Less drama and less noise so you can actually do you work, right!
5. It’s still clinical. Some of us are just ready to leave patient care for good – even if it’s just reading cases. We just want to not have to deal with insurance, medical jargon or medical drama.

Who can perform Utilization Review:

1. Physical therapists
2. Occupational therapists
3. Occupational therapist assistants
4. Physical therapist assistants
5. Speech therapists

All of the above can secure employment as a utilization reviewer.

But all I see are RN positions?

1. Please be patient. Take your time to search several pages on Indeed or other search engines.
2. See yourself job alerts to help alert you when rehabilitation appropriate positions arise
3. Make sure to search multiple phrases and not just utilization reviewer

We have had many students go on from taking our course to become therapists turned utilization reviewers – so we personally know this is possible.

For the assistants out there who are skeptical – yes it is tough but I just had a call with an OTA who performed an hiring interview for a UR position. So they are really interviewing and hiring assistants too!

Can Assistants be hired as Utilization Reviewers:

The answer is “yes”! OTA and PTA’s can work as utilization reviewers and in the utilization review/management field.

But I want to be 100% transparent that find and securing a UR position is more challenging for assistants. This is because as of 2020, there are only 3 companies which hire assistants for this role. So a utilization review position as an assistant is not impossible, but it is very competitive.

What Companies hire therapists as Utilization Reviewers:

Assistants: Anthem, MyNexus and Numotion

All of rehabilitation professionals:

● Fidelis

● Medrisk

● naviHealth

● CorVel Corporation

● Magellan Health

● myNEXUS 

● Centene Corporation

● American Specialty Health

● CareCentrix

● Netsmart

● Genex

● Anthem

● Encompass health

● Evicore

● Evolent Health

● Signify Health

Utilization Reviewer Salary:

According to Salary.com, “The average Utilization Review Specialist salary in the United States is $81,920 as of October 28, 2020, but the range typically falls between $72,790 and $90,470.”  This is as of October 28,2020 and it is unclear if this is the price for assistants who are utilization reviewers as well.

But to have a remote and full time position that pays this well is very rare!

Why choose to become a Utilization Reviewer?

You maybe hear myself or Dr. Mike Chua mention UR a lot and that's because its really one of the few positions where you will have a stable, full time career that is remote and that pays really well.

There are other career options out there, such as travel therapy recruiter or going on your own to become an entrepreneur, but this is one the best career options out there for someone looking for reliable employment at home. 

Utilization Reviewer Course:

If this article has inspired you to try to find a job in utilization review/management, then we do have a program that could help you with securing this career change.

Our course ‘Foundations In Utilization Review For Rehabilitation Professionals” is a job preparation course.  It includes:

-Free Resume Review

-Sample resumes and cover letters that yes, our students have successfully used to get hired

-Interview preparation

-Monthly job postings

-Resume, LinkedIn and Cover letter optimization guides

and more!

We have had many people go on to secure a utilization review position just 1 month after graduating and even our assistants are getting call backs!

If you are interested in purchasing or learning more, you can learn more about our Utilization Review Course here: https://alternativehealthcarecareers.com/courses/becomeautilizationreviewer.