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 #INDSAR #J-18808-Ljbffr