Physical Therapy Utilization Review Advisor

🔥 8 minutes ago

⛰️ Colorado – Remote

⛰️ Colorado – Remote

💵 $80k - $88k / year

⏰ Full Time

🟠 Senior

🔴 Lead

😶‍🌫️ Therapist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• Counsel physical therapists, occupational therapists, and physicians on the appropriate use, cadence, and duration of physical therapy services • Monitor the impact of physical therapy services provided to injured workers • Conduct medical necessity reviews to evaluate and implement services meeting client health needs • Promote quality, cost-effective physical therapy outcomes • Review medical records and physical therapy treatment plans against applicable guidelines • Determine medical necessity and appropriateness of physical therapy services and develop provider action plans • Provide clinical opinions and communicate with providers about therapy protocols and guidelines • Liaise and negotiate with therapists, physicians, and stakeholders to optimize patient care and resource use • Consult with the Sedgwick clinical team on difficult claims and recommend ways to improve care and claim outcomes • Support clinical product innovation with internal and external stakeholders • Document communications, decisions, and claim-process steps accurately and promptly • Participate in client meetings and calls to explain program results • Support complex claim roundtable discussions • Participate in quality assurance activities, audits, and peer reviews • Monitor relevant regulations, guidelines, and best practices and maintain compliance

🎯 Requirements

• Master’s degree from an accredited college or university in Physical Therapy required • Completion of the National Physical Therapy Examination (NPTE) required • 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 related to Physical Therapy, Occupational Therapy, Chiropractic Care, etc. • Extensive knowledge of medical practice guidelines and treatment protocols • Excellent oral and written communication skills, including presentation skills • PC literacy, including Microsoft Office products • Analytical and interpretive skills • Strong organizational skills • Excellent interpersonal skills • Excellent negotiating skills • Ability to create and complete comprehensive, accurate, and constructive written reports • Ability to work in a team environment • Ability to meet or exceed Performance Competencies

🏖️ Benefits

• Three medical plans to choose from • Two dental plans to choose from • Tuition reimbursement • 401(k) plan matching 50% of contributions up to the first 6% saved • 4 weeks PTO during the first full year • Vision insurance • Disability insurance • Life insurance • Employee assistance program • Flexible spending account or health savings account • Additional voluntary benefits