What are the responsibilities and job description for the Quality Utilization Reviewer I position at Children's of Alabama?
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
Credentials with Equivalent Qualifications:
Education with Equivalent Qualifications:
Experience with Equivalent Qualifications:
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
- 2 years in hospital setting or related field (i.e. third-party payer)
- Utilization review experience preferred
- Current AL licensure as RN or LPN
- Knowledge of third-party payer requirements in utilization review preferred
Credentials with Equivalent Qualifications:
- 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:
- Associate of Science Nursing in Nursing or Bachelors of Science or Arts in Nursing
Experience with Equivalent Qualifications:
- 2 Years Staff Level