Quality Utilization Reviewer I

Quality Utilization Reviewer I

Main Campus Lee Building Day Shift Utilization Management Req # 2789 Location 1620 4th Avenue South, Lee Building, Birmingham, Alabama Category Clinical Professional Schedule Full Time Work Schedule 8-Hour Shifts Schedule Description Monday - Friday 8:00 am - 4:30 pm

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In Utilization Management at Main Campus Lee Building

Work schedule will be Full-time on the Day Shift, Monday - Friday 8:00 am - 4:30 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 - Friday 8:00 am - 4:30 pm, Day Shift, 8-Hour Shifts

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