RN Utilization Review Specialist

Arkansas Foundation for Medical Care; Arkansas; On-site; USD 65,000 - 90,000; Full time

Job summary

Arkansas Foundation for Medical Care is seeking a Registered Nurse to analyze patient records, determine medical necessity, and support authorization processes in accordance with government policies. Role includes documentation, reporting, and occasional travel within Arkansas to perform site reviews.

Required: Diploma/Associate’s degree in nursing and AR RN licensure; 3 years clinical nursing experience. Desirable: QA/Utilization Review or coding experience; strong IT skills and HIT/EHR

Qualifications

• Required RN licensure in Arkansas (state license or multistate license) to practice in Arkansas.
• Desirable: Bachelor’s degree in nursing.
• Three (3) years clinical nursing experience.
• Desirable: Quality Assurance / Utilization Review and/or coding experience, QIO experience.
• Reliable, high-speed wireless internet service (Wi-Fi)

Responsibilities

• Review records accurately per AFMC policies and procedures.
• Provide oversight and follow-up for clinical questions for non-clinical staff.
• Write effective and accurate review summaries and submit within required timeframes.
• Refer cases not meeting medical necessity criteria to peer clinical reviewer daily.
• Maintain and organize files for recording and reporting per procedures.
• Travel within the state as needed for site visits.
• Prepare monthly reports and statistics as directed.
• Communicate with internal and external clients about utilization management requirements and procedures.
• Follow HIPAA and confidentiality guidelines.

Skills

Typing 50 wpm

MS Office

Communication skills

Confidentiality

Multitasking

Deadline-driven

ICD coding knowledge

HIT/EHR knowledge

Travel ability

Team collaboration

Education

Diploma or Associate’s degree in nursing

Bachelor’s degree in nursing

Tools

HIT/EHR systems

ICD coding tools

Job description

Arkansas Foundation for Medical Care is seeking a Registered Nurse to analyze patient records, determine medical necessity, and support authorization processes in accordance with government policies. Role includes documentation, reporting, and occasional travel within Arkansas to perform site reviews.

Required: Diploma/Associate’s degree in nursing and AR RN licensure; 3 years clinical nursing experience. Desirable: QA/Utilization Review or coding experience; strong IT skills and HIT/EHR