Job Details
Quality Utilization Reviewer I
Main Campus Lee Building Day Shift Utilization Management Req # 1947 Location 1620 4th Avenue South, Lee Building, Birmingham, Alabama Category Clinical Professional Schedule 7On-7Off Work Schedule 8-Hour Shifts Schedule Description 7am- 3:30pm, Monday- Sunday every other week after completion of orientationIn Utilization Management at Main Campus Lee Building
Work schedule will be 7on / 7off on the Day Shift, 7am- 3:30pm, Monday- Sunday every other week after completion of orientation.
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: 7am- 3:30pm, Monday- Sunday every other week after completion of orientation, Day Shift, 8-Hour Shifts
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