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Requisition Number 19-0014
Post Date 2/4/2019
Title Utilization Review Nurse
City Birmingham
State AL
Description Seeking LPNs!
The Utilization Review Nurse is responsible for answering phone calls and responding to faxed requests from providers for services that require prior authorization. The Utilization Review Nurse reviews requests for medical necessity using evidenced-based criteria or internal guidelines while maintaining compliance with departmental and federal regulations. This is an office based position with standard office hours, working in a phone/fax queue.
Check out our great benefits and learn more about a future with VIVA at vivahealthcareers.com
Requirements REQUIRED:
• High school Diploma or GED
• Current LPN License in good standing with the State of Alabama Board of Nursing
• Licensed Practical Nurse Certification
• 1 – 3 years of experience as an LPN in a hospital setting, private physician or ancillary vendor’s office
• Ability to research, read, and interpret health plan or governmental contracts, and medical policy guidelines
• Demonstrate excellent customer service skills through written and verbal communication
• Ability to meet strict deadlines and turnaround times
• Basic computer and data entry skills
• Ability to work during the core hours of operation in the office (8:00am to 5:00pm Monday through Friday) and overtime as needed
• Willingness to work in a high volume call center environment

PREFERRED:
• Utilization review or precertification experience utilizing InterQual or Milliman guidelines
• Relevant customer service or call center experience
• Phone Queue Experience
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An Equal Opportunity Employer