Physical Therapist – Utilization Review
Required: Current, active, and unrestricted Physical Therapy license issued by the Arkansas State Board of Physical Therapy.
Job Summary
Astyra is seeking a licensed Physical Therapist (PT) to join our Utilization Review and Management team. The PT will apply clinical judgment and critical thinking to evaluate medical necessity and treatment appropriateness for physical therapy and rehabilitative services. This position requires accurate abstraction and documentation of review data to support utilization determinations.
Key Responsibilities
- Review and analyze medical records to determine the medical necessity and appropriateness of physical therapy and rehabilitative services.
- Abstract and document review data accurately and timely, summarizing key findings and justifications in accordance with company and client standards.
- Compare clinical documentation to utilization criteria and evidence-based guidelines to ensure appropriate care and resource use.
- Issue approvals or initiate referrals to consulting physicians as needed, providing clear rationale for determinations.
- Ensure quality, accuracy, and compliance with productivity, QA, and contractual benchmarks.
- Collaborate with internal and external stakeholders to maintain open communication and consistent case handling.
- Contribute to process improvement initiatives and ongoing reassessment of review procedures.
- Maintain confidentiality and compliance with HIPAA policies at all times.
- Participate in cross-training to enhance team flexibility and coverage.
Experience & Qualifications
- Licensure: Current, active, and unrestricted Physical Therapy license issued by the Arkansas State Board of Physical Therapy.
- Education: Master’s degree or higher in Physical Therapy from an accredited program.
- Prior experience in Utilization Review/Management and case review required.
- Minimum 2 years of direct clinical experience as a Physical Therapist.
- Minimum 1 year of experience supporting individuals with developmental disabilities preferred.
- Strong written, analytical, and clinical reasoning skills.
- Familiarity with utilization management tools and criteria (e.g., InterQual, MCG).