RN Utilization Management Specialist: Optimize Care

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

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).