Utilization Review Nurse – Inpatient/Medicaid (Day Shift)

Children's of Alabama; Birmingham (AL); On-site; USD 60,000 - 80,000; Full time

Job summary

Children's of Alabama in Birmingham is seeking an UR Reviewer 1 for Utilization Management at the Main Campus Lee Building. The role conducts inpatient admission, concurrent, and observation reviews for AL Medicaid and other payers, with potential advancement to Reviewer 2 after training and management approval.

Requirements include graduation from an accredited Nursing or Social Work program, AL RN or LPN licensure, and 2 years in hospital or related experience; knowledge of payer requirements

Qualifications

• Graduate of an accredited School of Nursing or Social Work.
• 2 years in hospital setting or related field (i.e., third-party payer).
• Current AL licensure as RN or LPN.
• Knowledge of third-party payer requirements in utilization review preferred.

Responsibilities

• Perform inpatient admission, concurrent, and observation reviews based on criteria for AL Medicaid and other payers.
• Work within Utilization Management at Main Campus Lee Building; participate in training for progression to Reviewer 2.

Skills

RN licensure

LPN licensure

Utilization review knowledge

Payer requirements

Education

Associate of Science in Nursing

Bachelor of Science in Nursing

Job description

Children's of Alabama in Birmingham is seeking an UR Reviewer 1 for Utilization Management at the Main Campus Lee Building. The role conducts inpatient admission, concurrent, and observation reviews for AL Medicaid and other payers, with potential advancement to Reviewer 2 after training and management approval.

Requirements include graduation from an accredited Nursing or Social Work program, AL RN or LPN licensure, and 2 years in hospital or related experience; knowledge of payer requirements