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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