Supervisor Utilization Review

Children's of Alabama; Birmingham (AL); On-site; USD 60,000 - 82,000; Full time

Job summary

Children's of Alabama in Birmingham seeks a Nurse Reviewer 3 for Utilization Management at the Main Campus Lee Building. The role covers inpatient admission reviews, concurrent and observation reviews for BCBS AL, applying InterQual criteria and local policies.

Schedule is full-time, days, with on-call rotating weekend coverage. Requirements include Alabama RN licensure (single state or multi-state), Basic Life Support, and an Associate Degree in Nursing, plus at least 5 years of staff-level

Qualifications

• Licensed registered nurse with Alabama licensure or multi-state compact.
• BLS certification is required.
• Inpatient review experience preferred.

Responsibilities

• Perform inpatient admission reviews, concurrent reviews and observation reviews.
• Apply InterQual criteria and local policies for BCBS AL and other payers.
• Coordinate with Utilization Management on main campus and weekends.

Skills

RN AL Single State

RN AL NLC Multi State

RN Non-AL NLC Multi State

Basic Life Support

Education

Associate of Science Nursing

Job description

In Utilization Management at Main Campus Lee Building

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

Summary

The Nurse Reviewer 3 is responsible for performing inpatient admission reviews, concurrent reviews, and observation reviews primarily for BCBS AL patients, based on InterQual criteria and local policies. However, Nurse Reviewer 3 should also be capable of performing such reviews for AL Medicaid and other commercial payers if needed.

Credentials with Equivalent Qualifications

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
• * Basic Life Support

Education with Equivalent Qualifications

Essential:

• * Associate of Science Nursing in Nursing

Experience with Equivalent Qualifications

Essential:

• * 5 Years Staff Level

Schedule: Monday - Friday 8:00am - 4:30pm on call rotating weekend coverage, Day Shift, 8-Hour Shifts