Quality Utilization Reviewer
Listed on 2026-02-21
-
Healthcare
Healthcare Nursing
In Utilization Management at Main Campus Lee Building
Work schedule will be 7 on / 7 off on the Night Shift, Monday - Sunday every other week from 10:30p - 7:00a. (after training period)
SummaryThe UR Reviewer I 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).
Otherinformation
Knowledge of third party payer requirements in utilization review preferred.
Credentials with Equivalent QualificationsEssential:
- 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
Essential:
- Associate of Science Nursing in Nursing or Bachelors of Science or Arts in Nursing
Essential:
- 2 Years Staff Level
Schedule:
Monday - Sunday every other week from 10:30P - 7:00a, Night Shift, 8-Hour Shifts
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).