Quality Utilization Reviewer I

Quality Utilization Reviewer I Birmingham, AL Job Details 1 day ago Qualifications Nursing Inpatient Utilization review RN License Bachelor of Science Mid-level Associate of Science in Nursing Utilization management Bachelor of Science in Nursing Bachelor's degree in nursing LPN Associate Degree in Nursing Bachelor of Arts Nurse Licensure Compact (NLC) Full Job Description 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.

Summary:

The UR Reviewer 1 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:

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