Job Details
Quality Utilization Reviewer I
Main Campus Lee Building Evening Shift Utilization Management Req # 2790 Location 1620 4th Avenue South, Lee Building, Birmingham, Alabama Category Clinical Professional Schedule 7On-7Off Work Schedule 8-Hour Shifts Schedule Description Monday - Sunday every other week from 2:30 pm - 11:00 pmIn Utilization Management at Main Campus Lee Building
Work schedule will be 7on / 7off on the Evening Shift, Monday - Sunday every other week from 2:30 pm - 11:00 pm.
Summary:
The UR Reviewer 1 is responsible for performing inpatient admission, concurrent, and observation reviews based on pre-established criteria exclusively for AL Medicaid and all commercial payers other than BCBS AL. Upon successful completion of training by UR Reviewer 2 and with the approval of the UR Manager & Department Director, UR Reviewer 1 with LPN/RN licensure may advance to Reviewer 2 (if position becomes available).
Other information:
Education
- Graduate of an accredited School of Nursing or Social Work
Experience
- 2 years in hospital setting or related field (i.e. third-party payer)
- Utilization review experience preferred
Licensures, Certifications, and/or Registries
- Current AL licensure as RN or LPN
Knowledge, Skills, and Abilities
- Knowledge of third-party payer requirements in utilization review preferred
Credentials with Equivalent Qualifications:
Essential:
* Registered Nurse AL Single State or any of the following equivalent qualifications below:
- Registered Nurse AL NLC Multi State
- Registered Nurse Non-AL NLC Multi State
- Licensed Practical Nurse AL Only
- Licensed Practical Nurse AL NLC Multi State
- Licensed Practical Nurse Non-AL NLC Multi State
- Licensed Independent Clinical Social Worker
Education with Equivalent Qualifications:
Essential:
* Associate of Science Nursing in Nursing or Bachelors of Science or Arts in Nursing
Experience with Equivalent Qualifications:
Essential:
* 2 Years Staff Level
Schedule: Monday - Sunday every other week from 2:30 pm - 11:00 pm, Evening Shift, 8-Hour Shifts
About the Location
Discover what it’s like to live and work in Birmingham, Alabama
- Clinical Documentation Specialist Outpatient Birmingham, Alabama Clinical Professional Full Time
- Clinical Documentation Integrity Nurse Coordinator Birmingham, Alabama Clinical Professional Full Time
- Endoscopy Technician Minor Procedure OR Birmingham, Alabama Clinical Professional Full Time
Join Our Talent Network
You'll receive job alerts and career tips, along with direct emails from our recruiters. You'll also have the option to opt in to receive text messages from our recruitment team.
Looking to connect in person?
Check out our latest job fairs.