Utilization Review Manager - Home Care jobs in Arkansas

The Case Manager/Utilization Review Nurse is responsible for assisting in maintaining and monitoring the utilization review and quality assurance for the network. The MMC will coordinate the informational flow and work closely with the Medical Management Director and Medical Director(s). The MMC will process precertification requests, concurrent reviews and retrospective reviews. The MMC will review medical records to determine the appropriateness and medical necessity of admissions. The MMC will review the use of ancillary services and analyze out of network usage. The MMC will analyze and process referral requests. The MMC will assist the Medical Management Director with case management plans. The MMC must demonstrate the ability to work hard, consistently meet deadlines and be a good team player. A high degree of initiative and organizational skills are required. Must be trustworthy in controlling confidential information.

Requirements:

Registered Nurse or Licensed Practical Nurse unrestricted license in Arkansas or compact state required.

SHARP is seeking one full time LPN or RN or two part time LPN or RN.

Must have knowledge of nursing, minimum 2 years experience in a clinical or hospital setting including inpatient and outpatient care. Insurance terminology, DME products and use of InterQual criteria preferred. Must be able to review a medical records.

Normal professional office environment. Close eye work. Use of all office equipment. Frequently sitting, reaching, walking and standing. Lifting, carrying, pushing/pulling up to 30 pounds.

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Flexible spending account
• Free parking
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Education:

• Associate (Preferred)

Experience:

• EMR systems: 3 years (Required)

License/Certification:

• Nursing License (Required)

Work Location: In person