• 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.