Physical Therapy Utilization Review Advisor

🕒 July 14

⛰️ Colorado – Remote

⛰️ Colorado – Remote

💵 $80k - $88k / year

⏰ Full Time

🟠 Senior

🔴 Lead

😶‍🌫️ Therapist

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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 and implement services to meet client health needs • Promote quality, cost-effective physical therapy outcomes • Review medical records and PT treatment plans against appropriate 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 other stakeholders to optimize patient care and resource use • Consult with the Sedgwick clinical team on difficult claims and recommend improvements to 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 audits and peer reviews for quality assurance and improvement • Stay current with utilization-review 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 in Physical Therapy, Occupational Therapy, Chiropractic Care, and related areas • Extensive knowledge of reviewing, understanding, and applying 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, interpersonal, and negotiating skills • Ability to create comprehensive, accurate, and constructive written reports • Ability to work in a team environment • Ability to meet or exceed Performance Competencies • Ability to handle multiple priorities, deadlines, work-related stress, troubleshooting, problem solving, analysis, judgment, and discretion • Ability to perform computer keyboarding; travel as required

🏖️ Benefits

• Three medical plans to choose from • Two dental plans to choose from • Tuition reimbursement eligibility • 401K plan with a 50% match on contributions up to the first 6% saved • 4 weeks PTO in the first full year • Vision insurance • Disability insurance • Life insurance • Employee assistance program • Flexible spending or health savings account • Other additional voluntary benefits • Work-life balance • Caring culture