About the role
In Utilization Management at Main Campus Lee Building
Work schedule will be 7 on / 7 off on the Day Shift, 7 am - 3:30 pm, Monday - Sunday every other week after completion of orientation.
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
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 Only
- Licensed Practical Nurse AL NLC Multi State
- Licensed Practical Nurse Non-AL NLC Multi State
- Licensed Independent Clinical Social Worker
Essential:
Education with Equivalent Qualifications:
- Associate of Science Nursing in Nursing or Bachelors of Science or Arts in Nursing
Essential:
Experience with Equivalent Qualifications:
- 2 Years Staff Level
Schedule:
7 am - 3:30 pm, Monday - Sunday every other week after completion of orientation, Day Shift, 8-Hour Shifts
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