Utilization Review Nurse RN or LPN
On-site · Searcy, Arkansas, United States
Job Summary
Utilization Review Nurse RN or LPN needed to lead utilization management within a hospital setting. Responsibilities include coordinating utilization management and denial prevention, performing chart reviews to ensure the right care, right cost, and right time, and promoting clinical best practices. Must hold a current Arkansas RN license (RN or LPN) and have experience with ICD-CM and CPT coding. Requires strong communication with Medical Staff, patients, hospital associates, and insurers; ability to work under pressure; and participation in ongoing education. Knowledge of CMS, AFMC, and related regulations is preferred.
Required Qualifications
- Arkansas licensure as a RN (and/or LPN)
- Experience with ICD-CM and CPT coding systems
- Ability to communicate with Medical Staff, patients, and insurance companies
- Ability to perform chart review and utilization management activities
- Comfort working under pressure and making independent judgments
- Ability to participate in ongoing education and stay updated with CMS/AFMC guidelines
- Safety Sensitive: No (provided in job description)
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