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Physical Therapy Utilization Review Jobs in Indiana

ATI Physical Therapy

Physical Therapy Aide

Plainfield, IN · On-site

$14.75 - $17.75/hr

Effectively onboard new patients reviewing relevant paperwork, verifying benefits, and completion of medical forms. * Support Physical Therapist by preparing and cleaning treatment areas, as well as ...

ATI Physical Therapy

Physical Therapy Aide

Griffith, IN · On-site

$13.50 - $16.25/hr

Effectively onboard new patients reviewing relevant paperwork, verifying benefits, and completion of medical forms. * Support Physical Therapist by preparing and cleaning treatment areas, as well as ...

ATI Physical Therapy

Physical Therapy Aide

Portage, IN · On-site

$13.75 - $16.50/hr

Effectively onboard new patients reviewing relevant paperwork, verifying benefits, and completion of medical forms. * Support Physical Therapist by preparing and cleaning treatment areas, as well as ...

ATI Physical Therapy

Physical Therapy Aide

Portage, IN · On-site

$13.75 - $16.50/hr

Effectively onboard new patients reviewing relevant paperwork, verifying benefits, and completion of medical forms. * Support Physical Therapist by preparing and cleaning treatment areas, as well as ...

ATI Physical Therapy

Physical Therapy Aide

Shelbyville, IN · On-site

$14.25 - $17.25/hr

Effectively onboard new patients reviewing relevant paperwork, verifying benefits, and completion of medical forms. * Support Physical Therapist by preparing and cleaning treatment areas, as well as ...

ATI Physical Therapy

Physical Therapy Aide

Merrillville, IN · On-site

$14.75 - $17.75/hr

Effectively onboard new patients reviewing relevant paperwork, verifying benefits, and completion of medical forms. * Support Physical Therapist by preparing and cleaning treatment areas, as well as ...

ATI Physical Therapy

Physical Therapy Aide

Portage, IN · On-site

$13.75 - $16.50/hr

Effectively onboard new patients reviewing relevant paperwork, verifying benefits, and completion of medical forms. * Support Physical Therapist by preparing and cleaning treatment areas, as well as ...

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All JobsPhysical Therapy Utilization Review JobsPhysical Therapy Utilization Review Jobs in Indiana

Physical Therapy Utilization Review information

See Indiana salary details

$14

$30

$51

How much do physical therapy utilization review jobs pay per hour?

As of Sep 1, 2026, the average hourly pay for physical therapy utilization review in Indiana is $30.39, according to ZipRecruiter salary data. Most workers in this role earn between $21.25 and $38.65 per hour, depending on experience, location, and employer.

What is physical therapy utilization review?

Physical Therapy Utilization Review is a process in which healthcare professionals evaluate the necessity, efficiency, and appropriateness of physical therapy services provided to patients. Utilization review specialists assess patient records, treatment plans, and progress to ensure that therapy services are evidence-based and meet insurance or regulatory guidelines. This helps control healthcare costs, prevents unnecessary treatments, and ensures patients receive optimal care. Utilization review can be conducted by physical therapists, nurses, or other qualified professionals within insurance companies, hospitals, or third-party organizations.

What are the key skills and qualifications needed to thrive as a physical therapy utilization review specialist?

To thrive as a Physical Therapy Utilization Review specialist, you need a solid background in physical therapy, clinical assessment, and knowledge of insurance guidelines, typically requiring a valid PT license and clinical experience. Familiarity with utilization management software, electronic health records (EHR), and compliance documentation systems is often necessary. Strong analytical skills, attention to detail, and clear communication help in evaluating treatment plans and collaborating with providers. These competencies are essential for ensuring appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What are some common challenges faced in a physical therapy utilization review role, and how can I prepare for them?

Professionals in Physical Therapy Utilization Review often face the challenge of balancing clinical judgment with payer guidelines and policies. Reviewing cases requires strong attention to detail, as well as the ability to interpret medical records efficiently while ensuring compliance with insurance requirements. You may also encounter situations where you need to communicate complex decisions to clinicians or patients, so strong communication and negotiation skills are essential. Staying current with evidence-based practices and insurer protocols will help you navigate these challenges effectively.

What is the difference between Physical Therapy Utilization Review vs Physical Therapist?

AspectPhysical Therapy Utilization ReviewPhysical Therapist
CredentialsTypically requires a license in healthcare or related field, with additional training in utilization reviewRequires a state license as a licensed physical therapist, with DPT degree
Work EnvironmentMostly office-based, reviewing patient records and insurance claimsClinical settings, hospitals, outpatient clinics, providing direct patient care
Employer & Industry UsageInsurance companies, healthcare organizations, utilization review companiesHospitals, outpatient clinics, rehab centers, private practices

Physical Therapy Utilization Review focuses on evaluating the necessity and appropriateness of physical therapy services for insurance and healthcare compliance, often working behind the scenes. In contrast, a Physical Therapist provides direct patient care, developing treatment plans and performing therapy sessions. Both roles require healthcare knowledge, but their daily tasks and work environments differ significantly.

What are the most commonly searched types of Physical Therapy Utilization Review jobs in Indiana?

The most popular types of Physical Therapy Utilization Review jobs in Indiana are:

What are popular job titles related to Physical Therapy Utilization Review jobs in Indiana?

For Physical Therapy Utilization Review jobs in Indiana, the most frequently searched job titles are:

What job categories do people searching Physical Therapy Utilization Review jobs in Indiana look for?

The top searched job categories for Physical Therapy Utilization Review jobs in Indiana are:

What cities in Indiana are hiring for Physical Therapy Utilization Review jobs?

Cities in Indiana with the most Physical Therapy Utilization Review job openings:

Physical Therapy Utilization Review jobs near you
Infographic showing various Physical Therapy Utilization Review job openings in Indiana as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 20% Part Time, 1% Temporary, 4% Contract, and 1% Nights. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $63,218 per year, or $30.4 per hour.

Utilization Review Specialist

Innovative Hematology, Inc.

Indianapolis, IN • On-site

Full-time

Posted 18 days ago

Job description

About IHTC
At the Innovative Hematology (IHI), we offer a future where people with rare blood disorders flourish. Our experts provide the highest quality comprehensive services and holistic care to patients with bleeding, clotting and other hematologic disorders, and to their families.
What You Will Do
As the Utilization Review Specialist, you will be responsible for managing prior authorizations, medical necessity reviews, and payer-related requirements for specialty medications. This role works collaboratively with prescribers, pharmacists, clinic staff, and payers to facilitate timely access to medications while ensuring compliance with insurance guidelines, regulatory requirements, and organizational policies. The Utilization Review Specialist serves as a key resource in minimizing prescription delays, supporting reimbursement efforts, optimizing patient outcomes, and minimizing claim denials.
The Opportunity
  • Review incoming specialty medication referrals to identify insurance requirements, prior authorization needs, benefit limitations, coverage exclusions, and payer-specific criteria.
  • Conduct utilization review activities to assess medical necessity, appropriateness of therapy, and compliance with payer policies, clinical guidelines, and formulary requirements.
  • Initiate, prepare, submit, and track prior authorization requests for specialty medications through electronic portals, fax submissions, and verbal payer reviews.
  • Gather, analyze, and validate clinical documentation including chart notes, laboratory results, diagnostic testing, treatment history, and provider assessments to support authorization requests.
  • Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical information and ensure complete and accurate submissions.
  • Monitor authorization status and proactively follow up with insurance carriers, pharmacy benefit managers (PBMs), and third-party administrators to expedite approvals and minimize delays in therapy initiation.
  • Review payer-specific coverage criteria and determine documentation requirements for specialty therapies used in the treatment of hemophilia, von Willebrand disease, sickle cell disease, and other rare hematologic and bleeding disorders.
  • Evaluate denials and identify opportunities for appeal by reviewing payer rationale, medical records, and applicable clinical guidelines.
  • Prepare and submit first-level, second-level, and external appeal requests, including letters of medical necessity and supporting clinical documentation.
  • Maintain detailed records of authorization activities, payer communications, approval dates, denial reasons, appeal outcomes, and reauthorization requirements within pharmacy and electronic health record systems.
  • Track authorization expiration dates and proactively initiate renewal activities to ensure uninterrupted patient access to therapy.
  • Coordinate with clinical pharmacists and providers to address step therapy requirements, quantity limitations, formulary alternatives, and non-covered medication issues.
  • Serve as a liaison between providers, nurses, pharmacists, insurance carriers, manufacturer representatives, and pharmacy staff to facilitate timely access to specialty medications and ensure continuity of care.
  • Assist in identifying patients who may benefit from manufacturer copay assistance programs, patient assistance programs, grants, or alternate funding resources.
  • Monitor turnaround time benchmarks and productivity metrics to ensure timely completion of authorization requests and reauthorizations.
  • Communicate authorization determinations, coverage changes, and appeal outcomes to providers, pharmacy staff, and nursing in a timely and professional manner.
  • Participate in payer audits, accreditation reviews, and internal quality assurance initiatives by maintaining accurate and compliant documentation.
  • Ensure compliance with HIPAA, Medicare, Medicaid, commercial payer regulations, URAC and ACHC accreditation standards, organizational policies, and specialty pharmacy best practices.
  • Identify trends related to payer denials, authorization delays, and documentation deficiencies and provide recommendations for process improvement.
  • Analyze reports related to authorization volumes, approval rates, denial rates, appeal success rates, reimbursement outcomes, accounts receivable performance, and financial impact to support departmental and organizational goals.
  • Maintain a high level of customer service while managing sensitive patient information and complex reimbursement issues in a fast-paced specialty pharmacy environment.
  • Monitor pharmacy accounts receivable related to specialty medication claims, authorizations, and reimbursement activities. Investigate outstanding balances, payer underpayments, claim denials, payment variances, and reimbursement delays. Collaborate with billing, revenue cycle, pharmacy, providers, and payer representatives to resolve claim discrepancies, facilitate payment recovery, reduce aged receivables, and optimize reimbursement performance.

Knowledge:
  • Strong knowledge of utilization review, prior authorization, reauthorization, and appeals processes for specialty medications.
  • Strong understanding of specialty pharmacy reimbursement, claims adjudication, denial management, and revenue cycle processes.
  • Knowledge of commercial insurance, Medicare, Medicaid, managed care organizations, pharmacy benefit managers (PBMs), and medical benefit coverage policies.
  • Knowledge of specialty medication authorization, reauthorization, and appeals processes, including medical necessity reviews and payer-specific clinical criteria.
  • Knowledge of medical terminology, pharmaceutical terminology, disease state management, and clinical documentation requirements.
  • Knowledge of denial management processes, appeals strategies, reimbursement methodologies, and revenue cycle principles.
  • Knowledge of electronic health records (EHRs), pharmacy management systems, payer portals, and other healthcare technology platforms used to support utilization review and reimbursement activities.

Skills:
  • Proficiency in reviewing and interpreting clinical documentation, laboratory results, payer policies, and medical necessity criteria.
  • Excellent verbal and written communication skills with the ability to effectively communicate with providers, pharmacists, nurses, payers, patients, and manufacturer representatives.
  • Strong organizational and time management skills with the ability to prioritize multiple assignments and meet deadlines in a fast-paced environment.
  • Demonstrated attention to detail and accuracy in reviewing clinical documentation, authorization submissions, and payer communications.
  • Proficiency in electronic health records (EHR), pharmacy management systems, payer portals, and Microsoft Office applications, including Excel, Word, Outlook, and Teams.

Abilities:
  • Ability to adapt to changing payer requirements, technology platforms, accreditation standards, and healthcare regulations.
  • Ability to analyze coverage determinations, denial rationales, and reimbursement issues and develop effective resolution strategies.
  • Ability to exercise sound judgment and critical thinking when evaluating payer requirements, authorization requests, and reimbursement challenges.
  • Ability to navigate complex commercial, Medicare, Medicaid, and managed care insurance requirements.
  • Ability to work independently while collaborating effectively within a multidisciplinary healthcare team.

Requirements
  • High school diploma or GED
  • 3-5 years of related experience
  • All IHI employees are expected to enable multi-factor authentication via their personal smart phone/smart device in order to access IHI systems as a requirement of the role.

Benefits
IHI is a not-for-profit program based in Indianapolis and offers a competitive salary and benefit package.
IHI is the only ederally designated comprehensive hemophilia program in Indiana, and serves the entire state through services available in Indianapolis and at outreach clinics.
IHI is a leader in hemophilia care, education and clinical research and has a dedicated on-site multidisciplinary staff to ensure availability of a wide range of required services.
IHI participates in national and international clinical research, including new infusion products and therapies, investigation of long-term outcomes, and the impact of associated conditions. The IHTC research program provides patients access to new therapies, and an opportunity to improve care. Our center has more than 70 clinical research projects involving bleeding disorders, sickle cell disease, thrombosis and more.
The Indiana Hemophilia and Thrombosis Center is an Equal Opportunity Employer.

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