Job Information
Sedgwick Physical Therapy Utilization Review Advisor in Helena, Montana
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.
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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.
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.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
QUALIFICATIONS
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
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical : Computer keyboarding, travel as required
Auditory/Visual : Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
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.
Taking care of people is at the heart of everything we do. Caring counts
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)