Massachusetts Licensed Occupational Therapist

To support clinical coverage reviews for MassHealth LTSS, the remote Massachusetts Licensed Occupational Therapist will perform pre-service clinical coverage determinations, attend appeal hearings, and collaborate with team members to ensure compliance with medical necessity guidelines. Key responsibilities: Assess the appropriateness of services for prior authorizations based on documentation and guidelines Participate in appeal hearings and provide clinical mentorship to junior reviewers Maintain compliance with MassHealth clinical guidelines and support operational efficiency through collaboration Required qualifications: Current Massachusetts Occupational Therapist licensure Experience with clinical coverage reviews and prior authorization processes Ability to work independently and collaboratively in a remote setting Strong understanding of MassHealth policies and medical necessity guidelines Proficiency in clinical documentation and quality assurance practices