UHA JATLA
Evolent Health
Carmel,USA
22
Years of experience
Experienced Physical Therapist with over 20 years in clinical and utilization review across orthopedic, neurological, post-surgical, pediatric, home health, and workers' compensation care. Expertise in evidence-based utilization review, medical necessity determination, and regulatory audit support. Seeking to leverage clinical and problem-solving skills to contribute to innovative healthcare solutions.
Work History
Outpatient Physical Therapist
9 Months- Delivered individualized treatment plans for 25–30 post-surgical patients per week, achieving an average 15% faster recovery time compared to clinic benchmarks
- Applied advanced manual therapy, neuromuscular re-education, and progressive strengthening protocols to restore mobility and function
- Collaborated with orthopedic surgeons, nurses, and occupational therapists to ensure seamless continuity of patient care from inpatient to outpatient settings, enhancing overall recovery experience
- Educated patients and caregivers on home exercise programs and post-operative precautions, achieving a 95% adherence rate to long-term injury prevention strategies
- Educated patients and caregivers on home exercise programs, post-operative precautions, and long-term injury prevention strategies, resulting in a 95% adherence rate
- Led post-op group therapy sessions for total knee and hip replacement patients, increasing discharge readiness by 20% through targeted group support.
Physical Therapist, Skilled Nursing Facility
3 Years 1 Month- Collaborated with 20+ staff members to provide thorough, cohesive care plans
Assessed patient needs, generated specialized treatment plans, established timelines, and improving patient follow-through by interdisciplinary education.
Mentored DPT students in treatment techniques, reimbursement, and soft skills. Supervised PTAs on a daily basis per practice act.
Managed a diverse caseload, adapting treatment protocols to support patients’ unique recovery journeys
Participated in weekly case review meetings, fostering continuous improvement in clinical practice and patient care
Clinical Reviewer/Team lead
6 Years 1 Month- Partnered with senior management and cross-functional departments to shape clinical program, policy, and protocol development and implementation
- Reviewed case files for regulatory, accreditation, health plan, and medical group audits, ensuring strict compliance with applicable standards and enhancing overall audit quality
- Served on clinical audit and Evolent guideline committees, contributing clinical expertise to policy and guideline development
- Supported Medical Necessity Administration department by coordinating interdepartmental efforts, facilitating timely completion of assigned tasks to meet operational goals
- Conducted outreach calls as assigned to support timely, accurate case resolution
- Provided interdepartmental support to the Medical Necessity Administration department to ensure timely completion of assigned tasks
- Identified and resolved partner relationship issues proactively, addressing concerns quickly to maintain strong, trust-based partnerships
- Resolved critical issues by addressing concerns and facilitating communication between parties when necessary and ensured that they were resolved in a timely manner
- Operated independently in a fast-paced environment to meet deadlines and achieve objectives, receiving minimal guidance in a fast-paced environment
Clinical Quality Evaluator
10 Months- Conducted clinical appeals and InterQual medical necessity reviews to ensure compliance with established guidelines.
- Effectively communicated rationale for clinical decision-making to peers using evidence and outcomes-based principles
- Contributed insights to Utilization Review Committee discussions regarding patient care quality. and/or other committees as needed to present trends and issues.
- Developed, tracked, and managed Dashboard Reports to monitor key performance indicators.
- Collaborated with payors, benefits management, and case management to foster strong relationships and streamline processes.
- Supported clinical credentialing and medical record review of network practitioners as needed
Director of Rehabilitation
3 Years- Maintained more than 70% daily clinical productivity with direct patient care in an outpatient setting
- Ensured clinical management of the rehab department, including oversight of case management, quality improvement, care planning, clinical utilization, and patient identification
- Evaluated and treated a wide range of patients, including post-surgical, injured athletes, chronic and acute pain, workers' compensation, gait and balance, and high-functioning neurological cases
- Monitored staff compliance with facility policies and procedures for professional and paraprofessional roles
- Managed clinical operations of rehab department, overseeing case management, quality improvement, care planning, clinical utilization, and patient identification
- Hired, oriented, developed, and supported all staff and contract labor.
Travel Physical Therapist
7 Years- Applied diverse experience in orthopedic, neurological, acute care, and long-term care settings to enhance patient rehabilitation outcomes
- Evaluated, treated, and managed care for adolescent, adult, and geriatric patients with orthopedic, neurological, post-surgical, and work-related injuries, ensuring personalized treatment plans that facilitated recovery
- Delivered comprehensive patient assessments to develop tailored rehabilitation plans.
- Implemented evidence-based treatment strategies to enhance patient mobility and recovery outcomes.
- Collaborated with multidisciplinary teams to coordinate patient care and ensure continuity of services.
Education
Master of Science - Health Sciences
Bachelor of Physical Therapy - Physical Therapy
Skills
Clinical decision-making
Medical necessity criteria
Coverage determination knowledge
Proficiency with Denials management and appeals
Proficiency with DRG validation
coding concepts (ICD-10
CPT/HCPCS)
or UB-04 claim structure.
Claim adjudication knowledge
Healthcare clearinghouse experience
Clinical data analytics
Healthcare IT project management
Technology: IHIS
MS Office Suite
Excel
Adobe Premiere Pro
Allscripts
Epic
Rehab Optima
Casamba. Proficient with SharePoint
OneNote
Confluence
JIRA
Workday
UAT
Machinify and in the use of Internet/Intranet interfaces.
Agile learner/multi tasker/ team player
Clinical decision-making
Affiliations
- Member, American Physical Therapy Association (APTA)
- Member, Toastmasters
- Certified Yoga Teacher
Timeline
Clinical Reviewer/Team lead
Evolent Health
06.2020 - 07.2026Read More
Clinical Quality Evaluator
American Specialty Health
03.2019 - 01.2020Read More
Outpatient Physical Therapist
Concentra Clinic
06.2018 - 03.2019Read More
Physical Therapist, Skilled Nursing Facility
Cardon and Associates
02.2016 - 03.2019Read More
Director of Rehabilitation
Legacy Healthcare Services
01.2013 - 01.2016Read More
Travel Physical Therapist
Core Medical Group
01.2005 - 01.2012Read More
Manipal Academy of Higher Education
Bachelor of Physical Therapy from Physical Therapy
Read More
University of Indianapolis
Master of Science from Health Sciences
Read More