By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
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Physical Therapy Utilization Review Advisor
**PRIMARY PURPOSE** **:** 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; and promotes quality cost-effective physical therapy outcomes.
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment a are driven to deliver great work.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Reviews medical records and physical therapy (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.
+ Supports complex claim roundtable discussions.
+ 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.
**Education & Licensing**
Master's degree from an accredited college or university in Physical Therapy required. Doctorate degree in Physical Therapy preferred. Completion of the National Physical Therapy Examination (NPTE) and current license to practice as a Physical Therapist required.
**Experience**
Eight (8) years of related experience or equivalent combination of education and experience required.
**Skills & Knowledge**
+ 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
+ Excellent oral and written communication skills, including presentation skills
+ PC literate, 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
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**