Quality Utilization Reviewer I

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
• Licenses, 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

Essential

• 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 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

Schedule

8-Hour Shifts, 7am- 3:30pm, Monday- Sunday every other week after completion of orientation, Day Shift.