Physical Therapy Utilization Review Advisor

This is a fully remote position, open to applicants in Colorado.

📋 Description

• Provide guidance to physical therapists, occupational therapists, and physicians regarding the effective use, frequency, and duration of physical therapy services.

• Assess the effectiveness of physical therapy services delivered to injured workers.

• Perform medical necessity evaluations to assess and implement services that cater to client health requirements.

• Advocate for high-quality, cost-efficient physical therapy outcomes.

• Analyze medical records and physical therapy treatment plans in accordance with relevant guidelines.

• Establish the medical necessity and suitability of physical therapy services while formulating provider action plans.

• Offer clinical insights and engage with providers concerning therapy protocols and guidelines.

• Collaborate and negotiate with therapists, physicians, and stakeholders to enhance patient care and resource utilization.

• Consult with the Sedgwick clinical team regarding challenging claims and suggest improvements to care and claim outcomes.

• Foster clinical product innovation in partnership with internal and external stakeholders.

• Accurately and promptly document communications, decisions, and steps in the claim process.

• Engage in client meetings and calls to discuss program outcomes.

• Contribute to complex claim roundtable discussions.

• Take part in quality assurance initiatives, audits, and peer reviews.

• Keep abreast of relevant regulations, guidelines, and best practices to ensure compliance.

⛳️ Requirements

• A Master’s degree in Physical Therapy from an accredited institution is required.

• Successful completion of the National Physical Therapy Examination (NPTE) is mandatory.

• A current license to practice as a Physical Therapist is essential.

• A minimum of eight (8) years of relevant experience or an equivalent combination of education and experience is required.

• In-depth understanding of workers' compensation regulations and policies.

• Familiarity with current trends in Physical Therapy, Occupational Therapy, Chiropractic Care, etc.

• Comprehensive knowledge of medical practice guidelines and treatment protocols.

• Strong oral and written communication abilities, including effective presentation skills.

• Proficiency in PC applications, particularly Microsoft Office products.

• Strong analytical and interpretive capabilities.

• Exceptional organizational skills.

• Outstanding interpersonal abilities.

• Excellent negotiation skills.

• Competence in creating and delivering thorough, precise, and constructive written reports.

• Ability to work collaboratively within a team setting.

• Capacity to meet or surpass Performance Competencies.

🏝️ Benefits

• Options for three medical plans.

• Selection of two dental plans.

• Tuition reimbursement available.

• 401(k) plan with a 50% match on contributions up to the first 6% saved.

• Four weeks of paid time off (PTO) during the first full year.

• Vision insurance.

• Disability insurance coverage.

• Life insurance benefits.

• Employee assistance program access.

• Flexible spending account or health savings account options.

• Additional voluntary benefits offered.