RN - Registered Nurse - Utilization Management Specialist - AM (071)

UAB Medicine; Birmingham (AL); On-site; USD 61,000 - 99,000; Full time

Benefits offered by this job

Educational assistance

Paid time off

Wellness programs

Paid parental leave

PSLF eligible

Job summary

UAB Medicine, Alabama’s largest and most comprehensive health system, seeks a RN to perform utilization management activities and manage service authorization across hospital stays. You will communicate clinical details to insurers and support billing compliance while guiding payer reimbursement guidelines.

Requirements include a Bachelor’s degree in Nursing, 5 years of related experience, RN license in Alabama, BLS certification (ACLS/PALS may be needed).

Qualifications

• Bachelor's degree in Nursing and five (5) years of related experience required.
• Work experience may NOT substitute for education requirement.
• Currently licensed or eligible to be licensed as a Registered Nurse (RN) by the Alabama Board of Nursing required.
• Certified in Basic Life Support (BLS) from the American Heart Association (AHA) is required or should be obtained within 30 days of employment.
• Depending on the unit/department, Advanced Cardiac Life Support (ACLS) certification and/or Pediatric Advanced Life Support (PALS) from the American Heart Association (AHA) may be required.

Responsibilities

• Perform utilization management activities for all patients and manage service authorization during hospitalization.
• Communicate clinical detail and criteria to patient insurance carriers.
• Facilitate billing compliance and serve as a key hospital resource for payer reimbursement guidelines.
• Facilitate control of healthcare resources through ongoing assessment, monitoring and evaluation of patient financial resource utilization.

Skills

Utilization management

Communication with insurers

Clinical knowledge

Education

Bachelor's degree in Nursing

Registered Nurse (RN) license

Job description

Position Overview

Pay range: $60,835 - $98,855/ year

Shift: full-time AM

Schedule: 8 a.m.-5 p.m

Benefits and perks available for eligible positions include:

• robust educational assistance programs
• generous paid time off
• employee assistance and wellness programs
• paid parental leave
• qualifying employer for the Public Service Loan Forgiveness (PSLF) Program
• plus more.

Job Description

To perform utilization management activities for all patients and manage the authorization of services throughout the patient's hospitalization. To communicate clinical detail and criteria to patient insurance carriers. To facilitate billing compliance and serve as a key hospital resource for knowledge of payer reimbursement guidelines. To facilitate control of healthcare resources through ongoing assessment, monitoring and evaluation of patient financial resource utilization.

Qualifications

• Bachelor's degree in Nursing and five (5) years of related experience required.
• Work experience may NOT substitute for education requirement.
• Currently licensed or eligible to be licensed as a Registered Nurse (RN) by the Alabama Board of Nursing required.
• Certified in Basic Life Support (BLS) from the American Heart Association (AHA) is required or should be obtained within 30 days of employment.
• Depending on the unit/department, Advanced Cardiac Life Support (ACLS) certification and/or Pediatric Advanced Life Support (PALS) from the American Heart Association (AHA) may be required.

Why Work at UAB Medicine

We are UAB Medicine, Alabama’s largest and most comprehensive health system, recognized nationally for delivering world-class patient care, pioneering research, and cutting-edge medical education. We proudly serve more than 1.2 million patients each year - from every county in Alabama, all 50 states, and many countries around the world. Our network spans numerous hospitals, emergency departments, more than 67 other sites of care, and a team of over 3,100 physicians. Our key facilities include UAB Hospital - ranked the No. 1 hospital in Alabama by U.S. News & World Report and home to the state’s first ACS-verified Level I adult trauma center and only Magnet-designated hospital - along with UAB Hospital-Callahan Eye and five UAB St. Vincent’s hospitals serving central Alabama.

UAB Medicine offers careers across a wide range of practice environments, from our internationally renowned academic medical center and award-winning community hospitals to our primary and specialty care clinics across the state. Whether you’re seeking the fast-paced learning environment of a tertiary care setting or the close-knit environment of a community facility, there’s a place for you on our team where you can become part of a mission-driven organization committed to delivering life-changing care. With nearly every medical specialty represented and unlimited opportunities for growth, you’ll find the right fit for your skills and career goals. We care for you by offering comprehensive, industry-leading benefit packages to support the individual preferences and circumstances of our diverse staff.