Quality Utilization Reviewer II

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Website Children's of Alabama

Job Summary

The Nurse Reviewer 2 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 2 should also be capable of performing reviews for AL Medicaid and other commercial payers as needed.

Education

    • Graduate of an accredited School of Nursing

Experience

    • 5 years experience in hospital setting or related fields (i.e. 3rd party payer)
    • Utilization review experience preferred

Licensures, Certifications, and/or Registries

    • Current AL RN License