Physical Therapy Case Manager
Sedgwick
full-time
Posted on:
Location Type: Remote
Location: Colorado • United States
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Salary
💰 $80,000 - $88,000 per year
About the role
- 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.
- Promotes quality cost-effective physical therapy outcomes.
- 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.
Requirements
- 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.
- 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.
Benefits
- Three Medical, and two dental plans to choose from.
- Tuition reimbursement eligible.
- 401K plan that matches 50% on every $ you put in up to the first 6% you save.
- 4 weeks PTO your first full year.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
physical therapymedical necessity reviewstreatment protocolsutilization reviewclinical guidelinesworkers' compensation regulationsNational Physical Therapy Examinationmedical practice guidelinesquality assurance activities
Soft Skills
oral communicationwritten communicationpresentation skillsanalytical skillsorganizational skillsinterpersonal skillsnegotiating skillsteamworkreport writingproblem-solving
Certifications
Master’s degree in Physical TherapyDoctorate degree in Physical Therapycurrent license to practice as a Physical Therapist