Physical Therapy Utilization Review Advisor

Role Overview

• Counsels providers (physical therapists, occupational therapists, and physicians) as it pertains to the appropriate use, cadence, and duration of physical therapy services.
• Monitors the impact of physical therapy services provided to injured workers.
• Provides medical necessity reviews to evaluate and implement services to meet client health needs.
• Promotes quality cost-effective physical therapy outcomes.
• Reviews medical records and PT treatment plans to ensure they meet the appropriate guidelines while also ensuring best possible recovery.
• Determines the medical necessity and appropriateness of physical therapy services according to policy and develops action plans for providers as it pertains to current and future treatment.
• Provides clinical opinions regarding physical therapy needs and communicates with providers about therapy protocols and guidelines.
• Liaises and negotiates with physical therapists, occupational therapists, physicians, and other stakeholders to optimize patient care and promote effective use of resources.
• Consults with Sedgwick clinical team on difficult claims and provides recommendations tied to improving care and overall claim outcomes.
• Supports clinical product innovation for Sedgwick in conjunction with both internal and external stakeholders.
• Documents all communications, decisions, and steps taken in the claim process in a timely and accurate manner.
• Participates in client meetings and phone calls to explain program results.
• Participates in quality assurance activities, including audits and peer reviews, to ensure adherence to clinical guidelines and standards, as well as identifying opportunities for improvement.
• Stays updated with relevant industry regulations, guidelines, and best practices related to utilization review and maintains compliance with applicable laws and regulations.

Requirements

• Master’s degree from an accredited college or university in Physical Therapy required.
• Completion of the National Physical Therapy Examination (NPTE) and current license to practice as a Physical Therapist required.
• Eight (8) years of related experience or equivalent combination of education and experience required.
• Strong knowledge of workers' compensation regulations and policies.
• Knowledge of current trends as it pertains to Physical Therapy, Occupational Therapy, Chiropractic Care, etc.
• Extensive knowledge of reviewing, understanding, and applying medical practice guidelines and a rage of treatment protocols.
• PC literate, including Microsoft Office products.
• Excellent oral and written communication skills, including presentation skills.
• Analytical and interpretive skills.
• Strong organizational skills.
• Excellent negotiating skills.

Benefits

• Three Medical, and two dental plans to choose from.
• Tuition reimbursement eligible.
• 401K plan that matches 50% on every $ you put in up to the first 6% you save.
• 4 weeks PTO your first full year.