Sedgwick · 1 day ago
Physical Therapy Utilization Review Advisor
US Telecommuter
Full-time
Onsite
Senior Level, Lead/Staff
8+ years exp
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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.
Qualification
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Required
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 range 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
Preferred
Doctorate degree in Physical Therapy preferred.
Company
Sedgwick
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions.
10,001+ employees
Funding
Current Stage
Late StageTotal Funding
$1.5BKey Investors
Altas PartnersCaisse de Depot et Placement du Quebec
2024-09-12Private Equity· $1B
2018-12-01Private Equity· Undisclosed
2018-09-12Acquired· by The Carlyle Group ($6.7B)
Leadership Team
Michael Arbour
Chief Executive Officer
Kimberly George
Senior Vice President
Recent News
2024-11-15
2024-03-04
2024-01-22
Company data provided by crunchbase
