Utilization Review Specialist

Utilization Review Specialist - North Little Rock, AR (72113)

Are you an experienced healthcare professional looking for an opportunity to make a difference in patient care management? We're seeking a Utilization Review Specialist to join our team in North Little Rock, AR , helping ensure effective resource use while maintaining high-quality care within a managed care system.
About the Role:

This position plays a key role in reviewing patient care plans , collaborating with interdisciplinary teams, and ensuring compliance with insurance and regulatory requirements. The right candidate will be detail-oriented, organized, and able to manage multiple priorities in a fast-paced, office-based environment .
Key Responsibilities:

• Review and Update Records: Ensure patient records and care plans are accurate before submission to insurance providers.
• Admissions & Discharges: Verify documentation for new admissions and discharges is complete and timely.
• Daily Workflow: Prepare due lists, send update notifications, and follow up on pending authorizations.
• Utilization Review: Conduct pre-authorizations and concurrent reviews to confirm the necessity and appropriateness of care.
• Collaboration: Partner with providers, case managers, and other healthcare professionals to support effective care planning.
• Compliance: Maintain adherence to state, federal, and organizational guidelines.
• Appeals Management: Review and respond to appeals related to utilization decisions.
• Quality Initiatives: Participate in projects aimed at improving patient outcomes and operational efficiency.

Qualifications:

• Long-term care experience required
• Active COTA or PTA license
• Minimum 1 year of experience in MDS, COTA, PTA, or related field , preferably in a managed care setting
• Strong understanding of managed care principles and clinical guidelines
• Ability to handle a high caseload with excellent organizational skills
• Experience or willingness to learn systems such as PCC, Care Auth, Net Health, Availity , and Home & Community services
• Proficient in Microsoft Excel, Outlook, PDFs, and web-based platforms

Preferred Skills:

• Experience with Electronic Health Record (EHR) systems
• Strong multitasking abilities in a high-volume office setting
• Effective communication and problem-solving skills

Work Environment:

• On-site position at our North Little Rock, AR office
• Fast-paced, team-oriented environment requiring strong time management and attention to detail

If you are looking for a role where your skills directly contribute to improving patient care and operational outcomes, we'd love to hear from you. Apply today to join our team!

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