Quality Utilization Reviewer

Work schedule will be Full-time on the Day Shift, Monday
- Friday 8:00 am - 4:30 pm.

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).

• 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

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

Essential:

• Associate of Science Nursing in Nursing or Bachelors of Science or Arts in Nursing

Essential:

• 2 Years Staff Level

Schedule:

Monday
- Friday 8:00 am - 4:30 pm, Day Shift, 8-Hour Shifts