Idylla Realubit
Clinical Utilization Review Specialist | Clinical Care Management Reviewer | Doctor of Physical Therapy
Hire this person
Send a job offer directly to this candidate
About
Doctor of Physical Therapy with 17 years of progressive experience spanning home health, rehabilitation, outpatient care, and utilization management. Two years of direct experience in remote utilization review and authorization management with Optum/naviHealth (March 2022–August 2024), performing medical necessity reviews and post-acute care determinations for Medicare Advantage members. Extensive expertise in chart review, care coordination, clinical documentation, OASIS, interdisciplinary collaboration, and regulatory compliance.
Proven leadership experience as a Home Health PT Case Manager supervising PTAs, participating in case conferences, and driving patient-centered outcomes while reducing avoidable hospitalizations.
Experience
Home Health Care Coordinator / Utilization Reviewer - Optum / naviHealth
(2022-03 - 2024-08)
- Performed remote medical necessity reviews and concurrent authorization reviews for Medicare Advantage members requiring home health and post-acute services.
- Evaluated clinical documentation and determined appropriate levels of care using evidence-based guidelines and clinical criteria.
- Supported authorization decisions for rehabilitation and home health services and collaborated virtually with physicians, care managers, and providers.
- Ensured compliance with payer requirements and regulatory standards while maintaining timely and accurate documentation.
- Identified opportunities to improve patient outcomes and reduce avoidable utilization and hospital readmissions.
Co-Founder & Co-Owner - BodyRX Wellness Studio
(2026-02)
- Founded and oversee operations of a Doctor of Physical Therapy-led wellness and recovery studio.
- Develop clinical wellness programs and recovery protocols focused on pain management, recovery, and performance optimization.
- Lead strategic planning, business operations, marketing initiatives, and patient experience processes.
- Manage service delivery and client engagement while ensuring high standards of care and operational efficiency.
Physical Therapist (PRN) - Enhabit Home Health
(2025-04)
- Provide skilled home health physical therapy services, evaluations, and treatment interventions.
- Collaborate with interdisciplinary teams to optimize patient outcomes and promote safe transitions of care.
Physical Therapist (PRN) - CenterWell Home Health
(2026-04)
- Deliver home health rehabilitation services to medically complex patients.
- Perform evaluations, reassessments, and care coordination to support functional independence and prevent hospital readmissions.
Home Health Physical Therapist / Case Manager - WellCare Home Health & CenterWell Home Health
(2014-01 - 2022-12)
- Managed complex patient caseloads in home health and post-acute settings.
- Completed OASIS assessments and maintained compliant documentation within HCHB and EMR systems.
- Collaborated with physicians and interdisciplinary teams to coordinate care and optimize patient outcomes.
- Participated in case conferences and discharge planning meetings.
- Supervised and mentored PTAs and performed peer chart audits and quality reviews.
- Recommended continuation, modification, or discharge of services based on patient progress and medical necessity.
Sports Physical Therapist - Sports and Rehab Center (SPARC)
- Provided rehabilitation services for collegiate athletes and return-to-sport programs.
Outpatient Physical Therapist - St. Luke's Medical Center & Metropolitan Medical Center
- Delivered outpatient rehabilitation services across orthopedic and neurological populations.
Education
Doctor of Physical Therapy - Physical Therapy - University of Montana (2017-05)
Bachelor of Science - Physical Therapy - De La Salle University (2004-01 - 2009-12)


