Quality Utilization Reviewer I
Children's of Alabama, Birmingham, AL, United States
In Utilization Management at Main Campus Lee Building
Work schedule will be 7 on / 7 off on the Night Shift, Monday - Sunday every other week from 10:30p - 7:00a. (after training period)
Summary
The UR Reviewer I is responsible for performing inpatient admission, concurrent, and observation reviews based on pre-established criteria exclusively for Medicaid and commercial payers other than BCBS AL. Upon successful completion of training by UR Reviewer 2 and with approval of UM Manager & Department Director, UR Reviewer 1 with RN licensure may advance to Nurse Reviewer 2 (If position becomes available).
Other information
Knowledge of third party payer requirements in utilization review preferred.
Credentials with Equivalent Qualifications
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
Associate of Science Nursing in Nursing or Bachelor's of Science or Arts in Nursing
Experience with Equivalent Qualifications
2 Years Staff Level
Schedule
Monday - Friday 8:00am - 4:30pm, Day Shift, 8-Hour Shifts
Monday - Sunday (Night Shift) 7 on / 7 off, 10:30p - 7:00a after training.
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Work schedule will be 7 on / 7 off on the Night Shift, Monday - Sunday every other week from 10:30p - 7:00a. (after training period)
Summary
The UR Reviewer I is responsible for performing inpatient admission, concurrent, and observation reviews based on pre-established criteria exclusively for Medicaid and commercial payers other than BCBS AL. Upon successful completion of training by UR Reviewer 2 and with approval of UM Manager & Department Director, UR Reviewer 1 with RN licensure may advance to Nurse Reviewer 2 (If position becomes available).
Other information
Knowledge of third party payer requirements in utilization review preferred.
Credentials with Equivalent Qualifications
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
Associate of Science Nursing in Nursing or Bachelor's of Science or Arts in Nursing
Experience with Equivalent Qualifications
2 Years Staff Level
Schedule
Monday - Friday 8:00am - 4:30pm, Day Shift, 8-Hour Shifts
Monday - Sunday (Night Shift) 7 on / 7 off, 10:30p - 7:00a after training.
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