Physical Therapy Utilization Review Advisor

Sedgwick • Flagstaff, AZ • 1w ago

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.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

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

Similar Jobs

(USA) Staff Pharmacist (Hourly) - Sam's

Walmart • Flagstaff, AZ • 1w ago

Hospital & Medical

Position Summary... What you'll do... Provides comprehensive patient care to members by processing and accurately dispensing prescription orders administering immunizations counseling members regarding health care and pr...

1w ago

Go to Apply

Postdoctoral Scholar

Northern Arizona University • Flagstaff, AZ • 3w ago

Hospital & Medical

This job was posted by https://www.azjobconnection.gov : For more information, please see: https://www.azjobconnection.gov/jobs/7134575 r rPostdoctoral Scholar r rNorthern Arizona University r r Special Information This...

3w ago

Go to Apply

Physician (Primary Care) Flagstaff, AZ CBOC PCS EDRP

Veterans Affairs, Veterans Health Administration • Flagstaff, AZ • 3w ago

Hospital & Medical

Summary This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific eligibility requirements per VHA policy and submit your EDRP applica...

3w ago

Go to Apply

Physical Therapist - Center Manager $10K Sign-on Bonus

Select Medical • Flagstaff, AZ • 3w ago

Hospital & Medical

Overview Position: Physical Therapist - Outpatient Center Manager Location: 2912 N West St. Flagstaff, AZ 86004 Incentives: $10,000 Sign-on Bonus and $350/month Student Debt Benefit Schedule: Full-Time, Monday - Friday C...

3w ago

Go to Apply

In House Marketing Coordinator

Travel + Leisure Co. • Flagstaff, AZ • 15h ago

Sales & Marketing

We Put the World on Vacation Travel + Leisure Co. is the world's leading vacation ownership and travel membership company, with a dynamic and growing portfolio of resort, travel club, and lifestyle travel brands. Our ded...

15h ago

Go to Apply

Cook

Outback Steakhouse / Out West Restaurant Group • Flagstaff, AZ • 4d ago

Retail & Hospitality

Join for the Fun, Stay for the Career! If you are looking for a great place to work, have fun, and make money mate, click to apply. Come join the Outback family as a Cook, where you will be passionately preparing, portio...

4d ago

Go to Apply

(USA) Senior Meat Cutter

Walmart • Flagstaff, AZ • 4d ago

Position Summary... As a Senior Meat Cutter you will drive sales in your area to deliver to our members more of what they love, for less. You will work collaboratively with other associates to ensure the total club meets...

4d ago

Go to Apply

Breakfast Attendant

Drury Hotels • Flagstaff, AZ • 6d ago

Property Location:300 South Milton Road - Flagstaff, Arizona 86001You belong at Drury Hotels.Getting a job is just the beginning. Finding a place where you belong is what truly matters. Who you are and what you do makes...

6d ago

Go to Apply

Buffet Attendant

Drury Hotels • Flagstaff, AZ • 6d ago

Position is required to serve alcohol - must be 21+ years of age.Property Location:300 South Milton Road - Flagstaff, Arizona 86001You belong at Drury Hotels.Getting a job is just the beginning. Finding a place where you...

6d ago

Go to Apply

Customer Service Associate

Walgreens • Flagstaff, AZ • 6d ago

Management & Administrative

Job Description: Models and delivers a distinctive and delightful customer experience. Registers sales on assigned cash register, provides customers with courteous, fair, friendly, and efficient checkout service. Custome...

6d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.