Utilization Review Nurse; RN Home Health

Utilization Review Nurse (RN) – Home Health (Full‑time)

Monday‑Friday, 8:00 AM – 4:30 PM

Organization Overview

Washington Regional Medical System is a community‑owned, non‑profit health care system located in Northwest Arkansas. It has a 425‑bed medical center named the #1 hospital in Arkansas by U.S. News & World Report, and over 40 clinic locations, a Level II trauma center, and five Centers of Excellence.

Position Summary

The Home Health Utilization Review Nurse (RN) specializes in optimizing patient care by assessing the medical necessity, appropriateness, and efficiency of home health services. The role reports to the Home Health Manager and collaborates with interdisciplinary teams, physicians, and regulatory bodies to ensure compliance with CMS guidelines, facilitate prior authorizations, discharge planning, and promote cost‑effective care while maintaining high‑quality outcomes.

Essential Responsibilities

• Conduct utilization review of patient medical records to ensure appropriateness for home health services.
• Process prior authorizations, reauthorizations, and requests for extended care periods.
• Collaborate with physicians and the care team to coordinate care, identify needs, facilitate communication, and develop discharge plans.
• Monitor patient progress, outcomes, and resource utilization to promote cost‑effective care while ensuring quality and compliance with regulatory standards.
• Provide feedback to clinical staff regarding medical necessity, homebound status, visit frequency, utilization, and discharge planning.
• Work with department leaders to identify performance‑improvement opportunities and develop plans including staff education.
• Ensure compliance with organizational policies regarding timely service delivery and data reporting.
• Participate in the administrative on‑call rotation, including weekends and holidays.
• Collaborate with clinicians to ensure documentation meets CMS guidelines and is properly submitted and signed.
• Perform monthly supply audits.

Qualifications

• Education:
  
  Graduate of an accredited nursing program.
• Licensure &
  
  Certifications:
  
  Arkansas RN license (required), CPR (required), valid driver’s license and auto liability insurance (required).
• Experience:
  
  At least three years of clinical nursing experience in a home‑care and/or hospice setting (preferred); previous supervisory or management experience required.

Work Environment

This position involves up to 80% standing/walking, pushing, pulling, lifting or carrying up to 50 lb, and 20% sitting in a standard office environment. Exposure to bodily fluids and communicable diseases is possible.

Seniority Level

Mid‑Senior Level

Employment Type

Full‑time

Job Function

Health Care Provider – Hospitals and Health Care Industry