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Professional - Clinical

Utilization Mgmt PT/OT Thr Spc

Houston, TX, US
    Position: Utilization Mgmt PT/OT Thr Spc
    Talent Area: Professional - Clinical
    Full/Part Time: Full time
    Location: Houston, TX, US
    Regular/Temporary: Regular
    Department: UM Initial Authorizations
    Shift: 9a-6p
    Job ID: 407112

We are searching for a Utilization Management PT/OT Specialist -- someone who works well in a fast-paced setting. In this position, you will provide prior authorization of outpatient and home physical and occupational therapy services requiring authorization. This process includes using clinical judgement for utilization management, application of product benefits, understanding of regulatory requirements, and verification of medical necessity utilizing evidence-based criteria. 


Think you’ve got what it takes?


  • Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption
  • Degree in Physical or Occupational Therapy required
  • Master’s degree in Physical or Occupational Therapy preferred
  • Physical Therapist or Occupational Therapist license from the Texas Board of Physical or Occupational Therapy Examiners required
  • 5 years professional physical or occupational therapy and/or utilization management experience required


  • Assess the treatment plan, clinical information, and medical necessity of all requested services
  • Conducts timely entry of information into systems and assigns appropriate length of service per established guidelines, and communicate authorization numbers to providers and member
  • Reviews all demographic information generated by the utilization management assistant staff and communicates variances
  • Promotes provider satisfaction with ongoing education regarding managed care and the process and procedure of the authorization requirements
  • Collaborates with all disciplines within the health plan to meet goals and objectives
  • Refers potential members and collaborates with the case management team concerning medical history and current services being provided
  • Identifies potential quality of care issues, documents in the electronic system, and refers to appropriate Quality Management staff
  • Ensures that non-licensed staff function within the guidelines of regulatory standards and contractual requirements

About Texas Children’s

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 14,000+ dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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