Quality Utilization Reviewer I

In 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