... review, continued stay reviews, utilization review, prior authorizations, care coordination ... contract, • Holidays with coverage expectations include New Year's Day, Memorial Day ...
... review, continued stay reviews, utilization review, prior authorizations, care coordination ... contract, • Holidays with coverage expectations include New Year's Day, Memorial Day ...
... 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 ...
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 ...
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
Quick apply
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 ...
... criteria review, care coordination, discharge planning, disease management, needs assessment, DME ordering, plan of care development, and prior authorizations, • Familiarity with regulatory ...
... criteria review, care coordination, discharge planning, disease management, needs assessment, DME ordering, plan of care development, and prior authorizations, • Familiarity with regulatory ...
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
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 ...
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
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 ...
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
Estillfork, AL • On-site
Other
Re-posted 9 days ago
Job description
American Traveler is seeking an experienced RN Case Manager with inpatient case management experience and an active CA RN license for a primarily virtual role supporting complex cases across a health system and the community.
Job Details
• Primarily virtual position supporting complex cases across the health system and patients in the community,
• Occasional floating required between offices in Emeryville and San Francisco,
• Works across acute hospital and ambulatory settings,
• Day shift schedule: 5x8s, 8:00 AM-4:30 PM,
• Case management responsibilities include discharge planning, concurrent review, continued stay reviews, utilization review, prior authorizations, care coordination, admission criteria evaluation, and disease management,
• Patient ratio of 1:25,
• Epic EMR required,
• Teaching hospital experience required,
• Community hospital experience required,
Job Requirements
• Active CA RN license required,
• BLS certification required (AHA or ARC),
• Minimum 2 years of inpatient case management experience required,
• Travel nursing experience required,
• Epic EMR proficiency required,
• Experience with InterQual Criteria, DRG, CMS, and HIPAA guidelines required,
• Teaching hospital and community hospital experience required,
• Trauma Level I or II experience preferred,
• Charge nurse experience preferred,
• Ambulatory, behavioral health, and telephonic case management experience preferred,
• 2 supervisor references obtained within the past year required for consideration,
• 7-year work history verification required,
Additional Information
• Responsibilities include utilization review, medical necessity determinations, retrospective review, plan of care development, needs assessment, DME ordering, and benefits eligibility evaluation,
• Knowledge of CMS, DRG, HIPAA, and Joint Commission/Core Measures/National Safety Goals expected,
• Preferred specialty experience includes behavioral health, ED, ICU, SDU/PCU/IMC/Obs, and surgical services,
• Local candidates are accepted; candidates must reside more than 50 miles from the facility to qualify for travel pay rates,
• Former employees or travelers may return without a required separation period; former manager's name must be provided on the application (note: recruiter notes indicate a 1-year separation may apply - confirm with your recruiter),
• RTO is limited to a maximum of 7 days per contract; only 1 holiday may be requested off per contract,
• Holidays with coverage expectations include New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day,
• Any background or licensure disclosures must be accompanied by supporting documentation for facility HR review