Andrea S. Johnson
Seymour
Summary
Licensed Physical Therapist with 12 years of experience in skilled nursing facilities, providing care to Medicare, Medicare Advantage, and managed care populations. Extensive background in medical necessity determination, documentation review, continued stay justification, and discharge decision-making. Highly skilled in interpreting payer guidelines, producing audit-ready documentation, and collaborating with interdisciplinary teams. Seeking a full-time remote Utilization Review or Utilization Management position.
Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Physical Therapist
Skilled Nursing Facility
Indiana
06.2014 - Current
- Conduct comprehensive initial evaluations, re-evaluations, progress notes, and discharge summaries for medically complex patients.
- Determine skilled level of care and medical necessity for therapy services in accordance with Medicare Part A, Medicare Part B, and Medicare Advantage guidelines.
- Develop and update plans of care with appropriate frequency, duration, and intensity aligned with payer requirements and functional outcomes.
- Review patient progress and functional status to support continued stay, modification of services, or discharge recommendations.
- Produce audit-ready clinical documentation supporting skilled justification, continued services, and discharge planning.
- Apply utilization management principles to ensure appropriate resource use and compliance with payer criteria.
- Collaborate with physicians, nursing, case management, social work, and interdisciplinary teams to coordinate care.
- Support denial prevention efforts and provide documentation clarification for appeals when requested.
- Maintain productivity and turnaround standards while ensuring documentation accuracy and regulatory compliance.
- Demonstrate independent clinical judgment, time management, and written communication skills applicable to remote UR roles.
- Assessed patient mobility and functional abilities to design personalized therapy plans.
- Collaborated with nursing staff to ensure comprehensive patient care and support.
- Educated patients and families on rehabilitation techniques and home exercise programs.
- Implemented therapeutic exercises to improve strength, balance, and coordination.
- Monitored patient progress and adjusted treatment plans as needed for optimal recovery.
- Documented therapy sessions accurately in electronic medical records for compliance.
- Participated in interdisciplinary team meetings to coordinate patient treatment strategies efficiently.
- Maintained professional relationships with coworkers, supervisors, colleagues, vendors and other members of the healthcare team.
- Created individualized home exercise programs for outpatient therapy clients to improve health and wellness.
- Attended continuing education courses relevant to physical therapy practice.
- Ensured compliance with all applicable laws, regulations and standards related to physical therapy practice.
- Planned for discharges and communicated findings and progress in detailed reports.
- Provided guidance on appropriate lifestyle changes that support optimal health outcomes.
- Evaluated the effectiveness of treatments by observing responses to interventions.
- Supervised physical therapist assistants and aides, ensuring adherence to treatment plans and high-quality patient care.
Education
Master's Degree - Physical Therapy
Skills
- Utilization Review
- Medical Necessity Determination
- Medicare Compliance
- Managed Care Compliance
- Clinical Documentation Review
- Continued Stay Review
- Discharge Review
- InterQual Concepts
- MCG Concepts
- Skilled Level of Care Justification
- Appeals Support
- Regulatory Compliance
- Productivity Standards
- Remote Work Readiness
- Experienced in CASAMBA documentation
- Time management proficiency
- Clinical reasoning
- Progress monitoring
- Geriatric therapy
- Adaptive equipment
- Patient assessment
- Safety management
- Continuing education
- Orthopedic rehabilitation
- Patient evaluation
- Clinical documentation
- Treatment planning
- Discharge planning
- Interdisciplinary collaboration
- Medicare compliance
- Evidence-based practice
- Problem solving
- Time management
- Effective communication
- Functional testing
- Balance training
- Empathetic and patient
- Progress documentation
- Verbal and written communication
- Mobility improvement
- Head injury care
- Adaptive to changing environments
- Therapeutic massage
- Outpatient therapy background
- Joint mobilization
- Bilingual in English/Portuguese
- Gait analysis
Certification
Physical Therapist, Indiana, 05011346A, Active, Unrestricted
License
Physical Therapist, Indiana, 05011346A
Credentials
- MPT
- PT
Remote Work Readiness
- Experienced working independently with minimal supervision
- Comfortable with electronic medical records, clinical documentation systems, and productivity metrics
- Strong written communication and critical thinking skills
- Reliable, organized, and detail-oriented
Timeline
Physical Therapist
Skilled Nursing Facility
06.2014 - Current