Quality Utilization Reviewer I in Birmingham, AL

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