... experience with utilization review including admission criteria, appeals and denials, and ... contract with only 1 holiday request approved per contract, • Returning employees must have a ...
... experience with utilization review including admission criteria, appeals and denials, and ... contract with only 1 holiday request approved per contract, • Returning employees must have a ...
Quality Review Coordinator
Birmingham, AL · On-site
... private business and government utilization review, medical review, cost containment ... The incumbent creates allow or reject on each contract for which a decision has been rendered. The ...
Quality Review Coordinator
Birmingham, AL · On-site
... private business and government utilization review, medical review, cost containment ... The incumbent creates allow or reject on each contract for which a decision has been rendered. The ...
... private business and government utilization review, medical review, cost containment ... The incumbent creates allow or reject on each contract for which a decision has been rendered. The ...
... private business and government utilization review, medical review, cost containment ... The incumbent creates allow or reject on each contract for which a decision has been rendered. The ...
RN - Care Coordinator / Case Management - Travel Contract
Tuscaloosa, AL · On-site
$52 - $54/hr
RN - Care Coordinator / Case Management - Travel Contract Facility: DCH Health System Location ... Case Management / Utilization Review experience preferred * Associate Degree in Nursing required
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RN - Care Coordinator / Case Management - Travel Contract
Tuscaloosa, AL · On-site
$52 - $54/hr
RN - Care Coordinator / Case Management - Travel Contract Facility: DCH Health System Location ... Case Management / Utilization Review experience preferred * Associate Degree in Nursing required
Job Details • Day shift position, 8 hours per day, 40 hours per week (8:00 AM - 4:30 PM), • 31-week contract assignment, • Epic EMR used at this facility, Job Requirements • Active CA RN ...
Job Details • Day shift position, 8 hours per day, 40 hours per week (8:00 AM - 4:30 PM), • 31-week contract assignment, • Epic EMR used at this facility, Job Requirements • Active CA RN ...
Therapist
Owens Cross Roads, AL · On-site
... and Contract requirements. * Provides utilization review reports to referral source and sponsoring agencies. * Initiates family contact using professionally prescribed methods and techniques to ...
Therapist
Owens Cross Roads, AL · On-site
... and Contract requirements. * Provides utilization review reports to referral source and sponsoring agencies. * Initiates family contact using professionally prescribed methods and techniques to ...
Care Coordinator
Birmingham, AL · On-site
$18 - $24.25/hr
... contract benefits by evaluating the patient's needs and developing alternative plans of treatment that provides quality care. WORKFLOW For Utilization Review, work is received via telephone ...
Care Coordinator
Birmingham, AL · On-site
$18 - $24.25/hr
... contract benefits by evaluating the patient's needs and developing alternative plans of treatment that provides quality care. WORKFLOW For Utilization Review, work is received via telephone ...
Care Coordinator
$18 - $24.25/hr
... contract benefits by evaluating the patient's needs and developing alternative plans of treatment that provides quality care. WORKFLOW For Utilization Review, work is received via telephone ...
Care Coordinator
$18 - $24.25/hr
... contract benefits by evaluating the patient's needs and developing alternative plans of treatment that provides quality care. WORKFLOW For Utilization Review, work is received via telephone ...
BASIC FUNCTION Administer Utilization Review activities including: * Prospective, concurrent ... The incumbent also analyzes the patient's contract benefit structure during the review. During the ...
BASIC FUNCTION Administer Utilization Review activities including: * Prospective, concurrent ... The incumbent also analyzes the patient's contract benefit structure during the review. During the ...
BASIC FUNCTION Administer Utilization Review activities including: * Prospective, concurrent ... The incumbent also analyzes the patient's contract benefit structure during the review. During the ...
BASIC FUNCTION Administer Utilization Review activities including: * Prospective, concurrent ... The incumbent also analyzes the patient's contract benefit structure during the review. During the ...
Care Coordinator/RN
Birmingham, AL · On-site
Contract Duration: 6 Months + Required Skills & Experience * Bachelor's Degree * Experience in case management, utilization review, and care coordination. * Active License in good standing as a ...
Care Coordinator/RN
Birmingham, AL · On-site
Contract Duration: 6 Months + Required Skills & Experience * Bachelor's Degree * Experience in case management, utilization review, and care coordination. * Active License in good standing as a ...
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Therapy Coordinator
Arab, AL · On-site
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... utilization review, quality assurance, resident care conferences, admissions, department head ...
Therapy Coordinator
Arab, AL · On-site
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... utilization review, quality assurance, resident care conferences, admissions, department head ...
Therapy Coordinator
Arab, AL · On-site
$34 - $38/hr
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... utilization review, quality assurance, resident care conferences, admissions, department head ...
Therapy Coordinator
Arab, AL · On-site
$34 - $38/hr
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... utilization review, quality assurance, resident care conferences, admissions, department head ...
Therapy Coordinator
Arab, AL · On-site
$34 - $38/hr
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... utilization review, quality assurance, resident care conferences, admissions, department head ...
Therapy Coordinator
Arab, AL · On-site
$34 - $38/hr
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... utilization review, quality assurance, resident care conferences, admissions, department head ...
Therapy Coordinator
Arab, AL · On-site
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... utilization review, quality assurance, resident care conferences, admissions, department head ...
Therapy Coordinator
Arab, AL · On-site
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... utilization review, quality assurance, resident care conferences, admissions, department head ...
Director of Hospitality and Supply Chain
Alexander City, AL · On-site
$80 - $120/hr
... contract compliance, and budget oversight. Understanding of healthcare support services, including ... Ability to oversee cost-savings initiatives through product evaluation, utilization review, supply ...
Director of Hospitality and Supply Chain
Alexander City, AL · On-site
$80 - $120/hr
... contract compliance, and budget oversight. Understanding of healthcare support services, including ... Ability to oversee cost-savings initiatives through product evaluation, utilization review, supply ...
Contract Utilization Review information
What are the key skills and qualifications needed to thrive in contract utilization review?
To thrive in Contract Utilization Review, you need a solid understanding of medical terminology, insurance policies, and contract compliance, often supported by a healthcare-related degree or certification in utilization management. Familiarity with utilization review software, electronic medical records (EMR), and knowledge of regulatory standards such as CMS guidelines is essential. Strong analytical thinking, attention to detail, and effective communication skills are crucial for collaborating with care teams and insurers. These abilities ensure reviews are accurate, contracts are properly administered, and patient care meets organizational and payer requirements.
What does a contract utilization review do?
A typical day in Contract Utilization Review involves reviewing patient medical records, ensuring adherence to payer contracts and regulatory standards, and communicating with healthcare providers to validate medical necessity of services. Professionals in this role often collaborate with clinical staff, case managers, and insurance representatives to resolve discrepancies or authorization issues. The work is detail-oriented and deadline-driven, making organizational skills vital. This dynamic position offers significant opportunities to learn more about healthcare regulations and may serve as a stepping stone toward more advanced roles in healthcare administration or compliance.
What is a contract utilization review?
A Contract Utilization Review job involves analyzing and evaluating the usage of contracts to ensure compliance, cost-effectiveness, and efficiency. Professionals in this role review contract terms, monitor vendor performance, and assess utilization data to optimize contract value. They may work in industries such as healthcare, government, or procurement, ensuring that agreements are being properly executed. The goal is to identify areas for improvement, reduce waste, and enhance operational efficiency.
What are the most commonly searched types of Utilization Review jobs in Alabama? The most popular types of Utilization Review jobs in Alabama are:
What are popular job titles related to Contract Utilization Review jobs in Alabama? For Contract Utilization Review jobs in Alabama, the most frequently searched job titles are:
What job categories do people searching Contract Utilization Review jobs in Alabama look for? The top searched job categories for Contract Utilization Review jobs in Alabama are:
What cities in Alabama are hiring for Contract Utilization Review jobs? Cities in Alabama with the most Contract Utilization Review job openings:
Travel RN - Case Management/Utilization Review - Case Management
Madison, AL • On-site
Other
Re-posted 10 days ago
Job description
American Traveler is hiring an experienced RN Case Manager with a CA RN license and 5+ years of inpatient acute case management experience for a hospital-based role requiring discharge planning expertise.
Job Details
• Work in the acute hospital Case Management department,
• 13-week assignment on day shift, 5x8 hours (8:00 AM - 4:30 PM),
• Every other weekend required,
• Patient ratio of 1:10,
• Preferred experience with Epic charting system,
• May be assigned to Emergency Department, ICU, Medical-Surgical, or SDU/PCU/IMC/Observation units,
• Preferred experience in teaching hospital, community hospital, and LTAC settings,
Job Requirements
• Active CA RN license required,
• Current BLS certification required (AHA or ARC),
• Minimum 5 years of RN Case Management experience required,
• Inpatient Acute Case Management hospital experience required,
• Discharge planning experience required with specific facility experience noted,
• Prior travel nursing experience required,
• Preferred experience with InterQual Criteria and Milliman Guidelines,
• Preferred experience with utilization review including admission criteria, appeals and denials, and concurrent review,
• Preferred previous charge nurse experience,
• Preferred knowledge of CMS regulations and DRG (Diagnosis Related Groups),
• Two references from supervisors obtained within the past year required for consideration,
Additional Information
• Coordinate care and transitions planning throughout the acute care patient experience,
• Collaborate with physicians, utilization managers, medical social workers, and bedside RNs to ensure timely progression of patients to appropriate levels of care,
• Conduct patient assessments to determine readmission risk and screen for ancillary supportive services including Palliative Care,
• Review medical records to ensure patients meet level of care requirements and monitor length of stay,
• Screen 30-day readmissions and create effective transition plans in collaboration with interdisciplinary teams,
• Identify high utilizers and complex psychosocial cases, making appropriate referrals to community resources,
• Participate in patient rounds and interdisciplinary team meetings,
• Must reside within a 50-mile radius to qualify for local candidate rate,
• Holiday coverage required for one of the following: New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, or Christmas Day,
• Maximum RTO of 7 days per contract with only 1 holiday request approved per contract,
• Returning employees must have a separation period of at least 1 year to be eligible to return as a traveler,
• Compliance documentation, including lab work, must be completed within 3-5 days of contract signing,
• First-time travelers are not being considered for this position