Physical Therapy Utilization Review Advisor

Sedgwick

Counseling providers on appropriate physical therapy services while monitoring outcomes. Collaborating with stakeholders to optimize patient care in a comprehensive claims administration company.

Posted 6/17/2026full-timeRemote • Colorado • 🇺🇸 United StatesSeniorLead💰 $80,000 - $88,000 per yearWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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.

Benefits

Comp & perks

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.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

physical therapymedical necessity reviewstreatment protocolsutilization reviewclinical guidelinesquality assuranceauditspeer reviewsworkers' compensation regulationsmedical practice guidelines

Soft Skills

oral communicationwritten communicationpresentation skillsanalytical skillsorganizational skillsinterpersonal skillsnegotiating skillsteamworkproblem-solvingdecision-making

Certifications

Master’s degree in Physical TherapyNational Physical Therapy Examination (NPTE) license