Utilization Review Specialist

The Springs; North Little Rock, Northern (AR, KY); Hybrid; USD 48,000 - 64,000; Full time

Job summary

The Springs in North Little Rock, AR is seeking an experienced Utilization Review Specialist to join our on-site team. This role focuses on reviewing patient care plans, coordinating with interdisciplinary teams, and ensuring compliance with insurance and regulatory requirements.

You will manage admissions, discharges, authorizations, and appeals while supporting care planning initiatives in a fast-paced office setting.

Qualifications

• Long-term care experience required.
• Active COTA or PTA license.
• Minimum 1 year of experience in MDS, COTA, PTA, or related field.
• Strong understanding of managed care principles and clinical guidelines.
• Proficient with Microsoft Excel and common office software.

Responsibilities

• Review and update records before submission to insurers.
• Verify documentation for admissions and discharges.
• Prepare due lists, send update notifications, and follow up on authorizations.
• Conduct pre-authorizations and concurrent reviews.
• Collaborate with providers and case managers to support care planning.
• Maintain adherence to state, federal, and organizational guidelines.
• Review and respond to appeals related to utilization decisions.
• Participate in quality initiatives to improve patient outcomes.

Skills

Healthcare multitasking

Attention to detail

Organizational skills

Microsoft Excel

Effective communication

Education

COTA or PTA license

Tools

PCC

Care Auth

Net Health

Availity

Home & Community services

Job description

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