Quality Utilization Reviewer I

In Utilization Management at Main Campus Lee Building Work schedule will be Full-time on the Day Shift, Monday

• Friday 8:00 am - 4:30 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