Utilization Review Specialist The Wellstone Group North Little Rock, AR Job Details Full-time $65,000 - $68,000 a year 1 day ago Qualifications Long-term care facility experience Full 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 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! #INDSAR
