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Quality Utilization Reviewer I Children's of Alabama

• 4.

0 Birmingham, AL Job Details 16 hours ago Qualifications Nursing LICSW Inpatient experience Utilization review Bachelor's degree in social work RN License Bachelor of Science Mid-level Associate of Science in Nursing Utilization management Bachelor of Science in Nursing Resource utilization in healthcare Concurrent review in utilization management Bachelor's degree in nursing Medicaid LPN Social Work Associate Degree in Nursing Hospital experience Nurse Licensure Compact (NLC) Full Job Description 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 orientation In 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