Organization Overview, Mission, Vision, and Values

Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for five consecutive years by U.S. News & World Report. We employ 3,400+ team members and serve the region with over 40 clinic locations, the region’s only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.

Position Summary

The role of the Home Health Utilization Review Nurse (RN) reports to the Home Health Manager. This position specializes in optimizing patient care by assessing the medical necessity, appropriateness, and efficiency of home health services, including skilled nursing and therapies. Collaborating with interdisciplinary teams and physicians, this position ensures compliance with Centers for Medicare and Medicaid Services guidelines and other regulations, facilitates prior authorizations and discharge planning, and promotes cost-effective care while maintaining high-quality patient outcomes for homebound patients. This position reports to the Home Health Unit Manager.

Essential Position Responsibilities

• Conduct utilization review of patient medical records, including documentation, orders, and treatment ensure appropriateness for home health services
• Process prior authorizations, reauthorizations, and requests for extended care periods
• Collaborate with physicians, and other members of 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 to regulatory standards
• Provide feedback to clinical staff regarding medical necessity, homebound status, visit frequency and utilization, and discharge planning
• Collaborate with department leaders to identify performance improvement opportunities and develop performance improvement plans including staff education
• Ensure compliance with organizational policies regarding timely service delivery and data reporting
• Participate in the administrative on-call rotation that includes weekends and holidays
• Works with clinicians and department leaders to ensure clinician documentation is submitted, returned, and sent for signature following Center for Medicare Services guidelines
• Perform monthly supply audits

Qualifications

• Education: Must be a graduate of an accredited nursing program
• Licensure and Certifications: Arkansas RN license, required. CPR, required. Valid drivers license and auto liability insurance, required.
• Experience: Three years of clinical nursing experience in a home care and/or hospice setting, preferred. Previous experience in a supervisory and/or management role required.

Work Environment: This position will spend up to 80% of work time standing and/or walking while pushing, pulling, lifting and/or carrying up to 50 lbs. This position will spend 20% of time sitting while performing work in a standard office environment. This position will be exposed to bodily fluids and communicable diseases.