What are the responsibilities and job description for the Quality Utilization Reviewer I position at Children's of Alabama?
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Job Summary
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The UR Reviewer 1 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).
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Education
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Graduate of an accredited School of Nursing or Social Work.
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Experience
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2 years experience in hospital setting or related field (i.e. 3rd party payer)
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Utilization review experience preferred.
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Licensures, Certifications, and/or Registries
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Current AL licensure as LPN, RN or LCSW
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