Utilization Management Nurse
Company: AB Computing Systems Inc
Location: Little Rock
Posted on: June 25, 2025
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Job Description:
Title: Utilization Management Nurse Duration: 1 year Contract
Location: Little Rock, AR (100% Remote) Rate: $33-$35/hr on W2 Key
technologies: Internet Download speed—100 Mbps (confirming with
IT), Camera on with Team, Holiday availability (Flexible hours),
Reporting any issues to the leader ASAP, and maintaining
communication. Nice to have: Clinical review of prior approvals,
network exceptions, benefit inquiries, inpatient medical/surgical
admissions, outpatient procedures for providers, and/or other
contracted lines of business. Organized, able to adjust to
change/fast-paced environment Time zone: CST Number of Openings – 4
One position 8 am-5 pm (CST) Tuesday – Saturday One position 8 am-5
pm (CST) Sunday–Thursday One position 8 am-5 pm (CST) Monday–Friday
One position 11 am-7 pm (CST) Monday–Friday Job Summary Utilization
Management Nurse performs clinical review of prior approvals,
network exceptions, benefit inquiries, inpatient medical/surgical
admissions and outpatient procedures for providers, and/or other
contracted lines of business. This role assesses and evaluates the
efficiency and appropriateness of services for medical necessity
through interpretation and review with evidenced-based criteria,
clinical guidelines, corporate guidelines and policies and mandates
and standards. Incumbent also facilitates and promotes appropriate
care and quality toward cost effective and cost containment
measures based on evidence. Education & Experience: 1. Registered
Nurse License, active and unencumbered state license in the state
where job duties are performed is required. BSN preferred. 2. Four
(4) years of clinical practice nursing experience in at least one
of the following areas: medical-surgical nursing, surgical nursing,
intensive care or critical care nursing. 3. Proficiency using basic
computer skills in Microsoft Office such as Word, Excel, and
Outlook, including the ability to navigate multiple systems and
keyboarding 4. Experience in utilization management and/or medical
review preferred. Specialized Knowledge & Skills Ability to
prioritize and make sound nursing judgments through critical
thinking Excellent verbal and written communication skills Ability
to build collaborative relationships Attention to details Ability
to interpret complex documentation Ability to work independently
Professional Certification or Licenses: Registered Nurse License
Responsibilities Utilization Management: Conducts and monitors
clinical review cases to ensure medical necessity of inpatient and
outpatient services, diagnostic procedures, out-of-network
services, and surgery; documenting all relevant and specific
information; and screens, prioritizes and organizes determination
requests according to mandates and standards. Promotes appropriate
care and quality toward cost effective and cost containment
measures based on evidence. Communication: Collaborates with
healthcare providers and internal staff to promote quality of care,
cost effectiveness, accessibility and appropriateness of service
levels. Compliance: Practices nursing within the scope of licensure
and adheres to policies, procedures, regulations, URAC standards
and individual state regulations; making decisions based on facts
and evidence to ensure compliance, appropriate level of care, and
patient safety. Workflow: Proactively and efficiently work incoming
and outbound calls and/or queues from multiple sources within
mandated requirements. Knowledge: Remain current with up-to-date
medical and surgical procedures, products, healthcare services and
drugs, general trends in health care delivery; and enterprise
procedures, policies and contracts. Other duties as assigned. Work
Experience Utilization Review 2 years Care Management 2 years
Keywords: AB Computing Systems Inc, Pine Bluff , Utilization Management Nurse, Healthcare , Little Rock, Arkansas
