Indianapolis, Indiana, United States · Remote OK
Anticipated End Date: 2026-08-21 Position Title: Advanced Therapy Services Reviewer (Physical Therapist) Job Description: The Advanced Therapy Services Reviewer (Physical Therapist) is responsible for conducting timely a…
Skills: Clinical case evaluation, Medical necessity assessment, Physical therapy, Clinical documentation, Regulatory compliance
Lake Mary, Florida, United States · On-site
Anticipated End Date: 2026-08-14 Position Title: Pharmacy Technician, Fulfillment - BioPlus Specialty Pharmacy Job Description: Pharmacy Technician, Fulfillment - BioPlus Specialty Pharmacy Location: 3200 Lake Emma Road,…
Skills: Pharmacy technician, Prescription processing, Medication dispensing, Pharmacy adjudication platform, Inventory management
Taguig, Metro Manila, Philippines · On-site
Position Title: Associate Relations Specialist (PHL) Shift: 5:00 PM to 2:00AM (Philippines) Job Description: Responsible for serving as the primary point of contact for associates and management for non-complex associate…
Skills: Associate Relations, Employee Coaching, Policy Interpretation, Case Management, Employment Law
Miami, Florida, United States · Hybrid
Anticipated End Date: 2026-08-28 Position Title: Sr Test Analyst PBM Job Description: Sr Test Analyst PBM Hybrid: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity,…
Skills: Pharmacy benefit setup, Claims testing, Query testing, Formulary validation, Utilization management
Oakland, California, United States · Hybrid
$95k–$171k/yr
Anticipated End Date: 2026-08-28 Position Title: Regional Account Liaison - BioPlus Specialty Pharmacy - Bay Area, CA Job Description: Title: Regional Account Liaison - BioPlus Specialty Pharmacy Location(s): California-…
Skills: Sales Strategy, Account Management, Specialty Pharmacy, Oncology, Dermatology
Mayagüez, Puerto Rico, United States · Hybrid
Anticipated End Date: 2026-08-28 Position Title: Nurse Care Manager I (NCLEX) Job Description: Nurse Care Manager I Location: This role enables associates to work virtually full-time, except for required in-person traini…
Skills: Care Management, Clinical Assessment, Medical Necessity Review, Discharge Planning, Case Management
Indianapolis, Indiana, United States · Hybrid
Anticipated End Date: 2026-08-14 Position Title: Behavioral Health Compliance Senior Consultant (Compliance Consultant Senior) Job Description: Behavioral Health Compliance Senior Consultant (Compliance Consultant Senior…
Skills: Regulatory research, Audit coordination, Compliance monitoring, Risk assessment, Issue management
San Juan, Puerto Rico, United States · Hybrid
Anticipated End Date: 2026-08-14 Position Title: Cust Care Rep I-Bilingual (US) Job Description: Customer Care Representative I-Bilingual This role requires associates to be in-office 1 - 2 days per week, fostering colla…
Skills: Customer service, Bilingual, Spanish, Insurance benefits, Claims processing
Miami, Florida, United States · Remote OK
Anticipated End Date: 2026-08-28 Position Title: Therapy Services Specialist (Bilingual Spanish) Job Description: The Therapy Services Specialist (Bilingual Spanish) is responsible for working under the guidance of occup…
Skills: Occupational therapy, Physical therapy, Bilingual Spanish, Telephonic assessments, Virtual assessments
Norfolk, Virginia, United States · Remote OK
$110k–$165k/yr
Anticipated End Date: 2026-08-28 Position Title: Primary Care Nurse Practitioner, 100% Virtual Job Description: CareBridge Advance Practice Provider, Nurse Practitioner - Virginia $10,000 SIGN ON BONUS *Seeking Experienc…
Skills: Primary care, Acute care, Complex care management, Electronic medical records, Patient education
Montgomery, Alabama, United States · On-site
Anticipated End Date: 2026-08-15 Position Title: Family Nurse Practitioner (PRN) – Paragon Infusion Centers Job Description: Family Nurse Practitioner (PRN) – Paragon Infusion Centers Location: 3255 Malcolm Dr, Montgomer…
Skills: IV Therapy, Physical Assessment, Patient Education, Medication Mixing, Titration
Mason, Ohio, United States · Hybrid
Anticipated End Date: 2026-08-21 Position Title: Business Information Consultant Senior- PBM Business Strategy and Analytics Job Description: Business Information Consultant Senior- PBM Business Strategy and Analytics Lo…
Skills: Business Strategy, Data Analytics, SQL, Power BI, Tableau
West Des Moines, Iowa, United States · Hybrid
Anticipated End Date: 2026-08-07 Position Title: Nurse Practitioner, Bilingual, 100% Virtual, CareBridge Job Description: Nurse Practitioner, Bilingual, 100% Virtual, CareBridge Sign-On Bonus: $5,000 * Seeking Nurse Prac…
Skills: Bilingual Spanish, Complex Care Management, Telehealth, Electronic Medical Records, Clinical Care Planning
Gurugram, Haryana, India · On-site
Position Title: GenAI-Senior Software Engineer III-GR-39944-72584-1-JR191114 Job Family: IFT > Engineering/Dev Shift: Job Description: Job Title Senior Software Engineer III Requirement Type Full-Time Employee Job Locat…
Skills: GenAI, LLM, RAG, Python, PyTorch
St. Louis, Missouri, United States · Hybrid
Anticipated End Date: 2026-08-24 Position Title: Provider Contract Specialist Job Description: Provider Contract Specialist Shift: Monday - Friday Location: Must reside 30-45 miles from St. Louis, MO Hybrid 1: This role …
Skills: Provider Contracting, Contract Management, MS Excel, Communication Skills, Organizational Skills
Atlanta, Georgia, United States · Hybrid
Anticipated End Date: 2026-08-31 Position Title: Cloud & AI Security Architect Job Description: Cloud & AI Security Architect Location: This role requires associates to be in-office 1-2 days per week, fostering collabora…
Skills: Cloud Security Architecture, Cyber Defense, Threat Detection, Incident Response, CSPM
Gurugram, Haryana, India · On-site
Position Title: Software Engineer III (IND)- Artificial Intelligence-GR-39944-72521-JR189262 Job Family: IFT > Engineering/Dev Shift: Job Description: Job Title Software Engineer III Requirement Type Full-Time Employee …
Skills: LLM, RAG, Gen AI, Model optimization, FastAPI
Independence, Missouri, United States · On-site
Anticipated End Date: 2026-08-22 Position Title: Family Nurse Practitioner (PRN) – Paragon Infusion Centers Job Description: Family Nurse Practitioner (PRN) – Paragon Infusion Centers Location: 8434 Ward Parkway Kansas C…
Skills: IV Therapy, Physical Assessment, Patient Education, Medication Mixing, Titration
Los Angeles, California, United States · Remote OK
$22/hr–$25/hr
Anticipated End Date: 2026-08-14 Position Title: Outreach Care Specialist Job Description: Outreach Care Specialist Location: Virtual California: This role enables associates to work virtually full-time, except for requi…
Skills: Care Coordination, Case Management, Patient Assessment, Problem-solving, Facilitation
Atlanta, Georgia, United States · Hybrid
Anticipated End Date: 2026-08-21 Position Title: Risk Adjustment Compliance Manager Job Description: Risk Adjustment Compliance Manager Location: This role requires associates to be in-office 1 day per week, fostering co…
Skills: Risk Adjustment, Compliance Management, Regulatory Audits, Internal Audits, Gap Analysis
Indianapolis, Indiana, United States • Remote OK
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The reviewer conducts clinical case evaluations to determine the medical necessity of therapy services and ensures consistent, compliant decision-making. They also lead peer-to-peer calls with providers and document findings in accordance with regulatory standards.
Candidates must hold a BA/BS in physical therapy, occupational therapy, or speech language pathology with at least one year of clinical experience. A current, valid, and unrestricted professional license in the applicable state is required.
The Advanced Therapy Services Reviewer (Physical Therapist) is responsible for conducting timely and quality clinical case evaluations to determine the medical necessity of therapy service requests, ensuring prompt, consistent, and compliant decision-making.
Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
Conduct clinical case reviews to assess the medical necessity of therapy services (physical therapy).
Support medical management staff to ensure consistent, timely decisions for members and providers.
Lead peer-to-peer calls with therapist providers to gather clinical information and make determinations.
Render adverse determinations for specific clients when appropriate.
Document findings, develop analyses, and submit reports in compliance with regulatory standards. Apply company medical policies and guidelines consistently when making decisions.
Escalate cases requiring Medical Director review or policy interpretation.
Participate in departmental projects and initiatives. Maintain established quality and productivity standards.
Requires BA/BS in physical therapy, occupational therapy, or speech language pathology physical therapy and minimum of 1-year clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current valid, active and unrestricted license as a physical therapist, occupational therapist, or speech language pathologist in applicable state(s) required.
Master’s degree or higher in physical therapy strongly preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
