RN Utilization Review Specialist

Arkansas Foundation for Medical Care; Fort Smith (AR); On-site; USD 65,000 - 85,000; Full time

Job summary

Arkansas Foundation for Medical Care is seeking a Registered Nurse to perform utilization review by analyzing patient records for medical necessity under government reimbursement rules. Work may include prior authorization, concurrent review, or post-service assessment, with guidance from physician leadership.

The candidate should hold an Arkansas RN license (diploma/associate degree; BSN desirable) with 3 years of clinical nursing experience, knowledge of ICD-9/ICD-10 coding, and HIT/EHR

Qualifications

• RN licensed in Arkansas with diploma/associate degree; BSN desirable.
• Minimum three years of clinical nursing experience.
• Familiarity with ICD-9/ICD-10 coding and HIT/EHR systems.

Responsibilities

• Review patient records for medical necessity per policies.
• Provide oversight for clinic-related questions to non-clinical staff.
• Write accurate review summaries within required timeframes.
• Refer non-qualifying cases to a peer clinical reviewer daily.
• Maintain and report filing per established procedures.
• Travel within Arkansas for site visits as needed.

Skills

Nursing

Utilization Review

Medical Terminology

HIPAA Compliance

HIT/EHR

ICD-10 Coding

Time Management

Communication Skills

Multitasking

Teamwork

Education

Diploma or Associate's degree in nursing

Bachelor's degree in nursing (Desirable)

Tools

ICD Coding (ICD-9/ICD-10)

HIT/EHR Systems

Microsoft Office (Excel/Word)

Job description

Arkansas Foundation for Medical Care is seeking a Registered Nurse to perform utilization review by analyzing patient records for medical necessity under government reimbursement rules. Work may include prior authorization, concurrent review, or post-service assessment, with guidance from physician leadership.

The candidate should hold an Arkansas RN license (diploma/associate degree; BSN desirable) with 3 years of clinical nursing experience, knowledge of ICD-9/ICD-10 coding, and HIT/EHR