Top 14 Utilization review Jobs in Van Buren, Ar

Clinical Services Specialist RN
AFMC —Fort Smith, AR
- Full-time
- Nursing
- Microsoft Outlook
- RN License
Credentialing/Authorizations Specialist
Lumina Revenue Cycle Management —Van Buren, AR
- From $11 an hour
- Full-time
- Hybrid work
- Background check
- HIPAA
- High school diploma or GED
- Health insurance
- Dental insurance
Quick Apply
RN Nursing Manager I - MDS
The State of Oklahoma —Sequoyah County, OK
- $43 an hour
- Full-time
- Nursing
- RN License
- Writing skills
10d
Board Certified Behavior Analyst (BCBA) - Remote
All Care Therapies —Fort Smith, AR
- $43 - $56 an hour
- Part-time
- HIPAA
- Psychology
- Mentoring
Quick Apply
10d
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance
Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- LVN
- RN License
- Mid-level
- Travel reimbursement
- Health savings account
Quick Apply

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Credentialing/Authorizations Specialist
Lumina Revenue Cycle Management —Van Buren, AR
*Experience:* Some experience in medical billing, insurance authorization, or a related field is strongly preferred. Pay is dependent upon experience.
From $11 an hour
Quick Apply
Nurse Practitioner or Physician Assistant - SALLISAW, OK
Senior PsychCare —Fort Smith, AR
Must have a valid driver’s license and be comfortable traveling locally. Strong clinical infrastructure with administrative and tech support.
Up to $165,000 a year
Quick Apply

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UR Coordinator, Full Time
RiverVista Behavioral Hospital —Columbus, OH
High school diploma required; associate or bachelor’s degree in nursing, healthcare administration, or related field preferred. Must be 21 or older.
$24 - $32 an hour
Quick Apply
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…

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Clinical Services Specialist RN

AFMC -
Fort Smith, AR

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Job Details

Full-time

Qualifications

Customer communication
Employee relationship building
English
Patient care

Full Job Description

Job Description:

SCOPE OF POSITION:
Responsible for analyzing patient records to determine legitimacy and necessity of medical services in compliance with government reimbursement policies. Review may be prior authorization, concurrent with service or post service. Review findings may be referred to a physician advisor for final determination. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence, Accountability, Respect and Teamwork.

ESSENTIAL JOB FUNCTIONS:
1. Review each selected record accurately and according to AFMC, state and federal policies and procedures.
2. Function as a resource for non-clinical staff by providing oversight and follow-up for clinical related questions or issues
3. Write effective and accurate review summaries and submit within appropriate time frame.
4. Refer all cases that do not meet established medical necessity criteria for approval to a peer clinical reviewer on a daily basis.
5. Maintain files for recording and reporting in accordance with established procedures.
6. Perform site surveys as required or directed if relevant to your department. Must be able to travel within the State as needed to accomplish required site visits if relevant to your department.
7. Prepare monthly reports and/or statistics as directed.
8. Communicate effectively with internal and external clients. Upon request, verbally informs patients, facility personnel, the attending physician and other ordering providers, and health professionals of specific utilization management requirements and procedures
9. Seek direction from Manager Clinical Services, Director Clinical Services, Associate Medical Director, or Medical Director for any clinical related questions or issues during the review process.
10. Daily quotas may be added to meet contract deliverables as needed.
11. Adhere to format, content, and style guidelines, giving consideration to usability and ensuring accuracy, consistency, and quality.
12. Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
13. Additional duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES:

Intermediate level computer skills (Excel, Word, Access, PowerPoint, and Outlook).
Type 40 wpm.
Exceptional skills in business English and spelling are required.
Ability to maintain confidentiality.
Strong oral and written communication skills.
Creativity.
Customer service.
Ability to meet deadlines.
Attention to detail.
Flexibility.
Knowledge of ICD 9/ICD 10 Coding.
Knowledge of HIT/EHR.
Medical terminology.
Ability to work collaboratively and independently to achieve stated goals.
Initiative.
Ability to relate professionally and positively with staff, business partners, customers, constituents, recipients, and the public.
Ability to multitask.
Ability to prioritize.
Strong organizational skills.
Problem solving skills.
Professionalism.
Project management skills.
Ability to read, interpret and apply laws, rules, and regulations.
Knowledge of quality improvement processes and techniques.
Time management skills.
Ability to travel, including overnight travel.

Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices):
Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.

EDUCATION:
Required: Diploma or Associate’s degree in nursing, licensed as a Registered Nurse in the state of Arkansas without restrictions or licensed as a multistate Registered Nurse and can practice in the state of Arkansas.
Desirable: Bachelor’s degree in nursing

EXPERIENCE:
Required: Three (3) years clinical nursing experience
Desirable: Quality Assurance / Utilization Review and/or coding experience, QIO experience

INTERNET REQUIREMENTS:
Reliable, high-speed wireless internet service (Wi-Fi)

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utilization review jobs in van buren, ar

Clinical Services Specialist RN

Credentialing/Authorizations Specialist

RN Nursing Manager I - MDS

Board Certified Behavior Analyst (BCBA) - Remote

Utilization Management Reviewer

Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license

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