Physical Therapy Utilization Review Advisor

Sedgwick

. Counsel physical therapists, occupational therapists, and physicians on the appropriate use, cadence, and duration of physical therapy services .

Posted 10/8/2026full-timeRemote • Colorado • United StatesSeniorLead💰 $80,000 - $88,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Physical Therapy practices, including medical necessity evaluations and compliance with workers' compensation regulations. Strong communication and negotiation skills are essential for liaising with healthcare providers and optimizing patient care.

Highest-signal resume keywords

Master’s Degree In Physical TherapyNational Physical Therapy Examination (NPTE)Current Physical Therapist LicenseWorkers' Compensation Regulations KnowledgeMedical Practice Guidelines Expertise

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Necessity ReviewsPhysical Therapy Treatment PlansClinical OpinionsQuality Assurance ActivitiesAnalytical SkillsReport WritingRegulatory Compliance Monitoring

Soft Skills

Excellent Oral CommunicationExcellent Written CommunicationStrong Organizational SkillsExcellent Interpersonal SkillsNegotiation Skills

Tools & Technologies

Microsoft Office Products

Certifications & Qualifications

Current Physical Therapist License

Industry Keywords

Physical TherapyOccupational TherapyChiropractic CarePatient Care OptimizationCost-Effective Outcomes

About the role

Key responsibilities & impact

Counsel physical therapists, occupational therapists, and physicians on the appropriate use, cadence, and duration of physical therapy services
Monitor the impact of physical therapy services provided to injured workers
Conduct medical necessity reviews to evaluate and implement services meeting client health needs
Promote quality, cost-effective physical therapy outcomes
Review medical records and physical therapy treatment plans against applicable guidelines
Determine medical necessity and appropriateness of physical therapy services and develop provider action plans
Provide clinical opinions and communicate with providers about therapy protocols and guidelines
Liaise and negotiate with therapists, physicians, and stakeholders to optimize patient care and resource use
Consult with the Sedgwick clinical team on difficult claims and recommend ways to improve care and claim outcomes
Support clinical product innovation with internal and external stakeholders
Document communications, decisions, and claim-process steps accurately and promptly
Participate in client meetings and calls to explain program results
Support complex claim roundtable discussions
Participate in quality assurance activities, audits, and peer reviews
Monitor relevant regulations, guidelines, and best practices and maintain compliance

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) required
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 related to Physical Therapy, Occupational Therapy, Chiropractic Care, etc.
Extensive knowledge of medical practice guidelines and treatment protocols
Excellent oral and written communication skills, including presentation skills
PC literacy, 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

Comp & perks

Three medical plans to choose from
Two dental plans to choose from
Tuition reimbursement
401(k) plan matching 50% of contributions up to the first 6% saved
4 weeks PTO during the first full year
Vision insurance
Disability insurance
Life insurance
Employee assistance program
Flexible spending account or health savings account
Additional voluntary benefits