... contractual requirements. Responsibilities * Lead and oversee the Utilization Management (UM ... Review and approve requests for specialty referrals, diagnostics, and procedures to ensure medical ...
New
Quick apply
... contractual requirements. Responsibilities * Lead and oversee the Utilization Management (UM ... Review and approve requests for specialty referrals, diagnostics, and procedures to ensure medical ...
New
... contractual requirements. * Lead and oversee the Utilization Management (UM) program across ... Review and approve requests for specialty referrals, diagnostics, and procedures to ensure medical ...
New
... contractual requirements. * Lead and oversee the Utilization Management (UM) program across ... Review and approve requests for specialty referrals, diagnostics, and procedures to ensure medical ...
New
Quality Review Coordinator
Birmingham, AL · On-site
... private business and government utilization review, medical review, cost containment ... the health insurance program administered by this corporation. The incumbent must be able to ...
Quality Review Coordinator
Birmingham, AL · On-site
... private business and government utilization review, medical review, cost containment ... the health insurance program administered by this corporation. The incumbent must be able to ...
Quality Review Coordinator
Birmingham, AL · On-site
... private business and government utilization review, medical review, cost containment ... the health insurance program administered by this corporation. The incumbent must be able to ...
Quality Review Coordinator
Birmingham, AL · On-site
... private business and government utilization review, medical review, cost containment ... the health insurance program administered by this corporation. The incumbent must be able to ...
... questions and reviews policy forms o Analyze contractual insurance requirements and analyze client needs. o Verifies documentation received from Jr. AE regarding new & renewal business.
... questions and reviews policy forms o Analyze contractual insurance requirements and analyze client needs. o Verifies documentation received from Jr. AE regarding new & renewal business.
... questions and reviews policy forms o Analyze contractual insurance requirements and analyze client needs. o Verifies documentation received from Jr. AE regarding new & renewal business.
... questions and reviews policy forms o Analyze contractual insurance requirements and analyze client needs. o Verifies documentation received from Jr. AE regarding new & renewal business.
... questions and reviews policy forms o Analyze contractual insurance requirements and analyze client needs. o Verifies documentation received from Jr. AE regarding new & renewal business.
... questions and reviews policy forms o Analyze contractual insurance requirements and analyze client needs. o Verifies documentation received from Jr. AE regarding new & renewal business.
BASIC FUNCTION Administer Utilization Review activities including: * Prospective, concurrent ... The plan of care may require contractual arrangements to be set up with providers, patient and ...
BASIC FUNCTION Administer Utilization Review activities including: * Prospective, concurrent ... The plan of care may require contractual arrangements to be set up with providers, patient and ...
BASIC FUNCTION Administer Utilization Review activities including: * Prospective, concurrent ... The plan of care may require contractual arrangements to be set up with providers, patient and ...
BASIC FUNCTION Administer Utilization Review activities including: * Prospective, concurrent ... The plan of care may require contractual arrangements to be set up with providers, patient and ...
Care Coordinator
Birmingham, AL · On-site
$18 - $24.25/hr
Utilization review activities may include prospective, concurrent, retrospective and appeals ... The plan of care calls for contractual arrangements to be set up with providers, patient and family.
Care Coordinator
Birmingham, AL · On-site
$18 - $24.25/hr
Utilization review activities may include prospective, concurrent, retrospective and appeals ... The plan of care calls for contractual arrangements to be set up with providers, patient and family.
Care Coordinator
Birmingham, AL · On-site
$18 - $24.25/hr
Utilization review activities may include prospective, concurrent, retrospective and appeals ... The plan of care calls for contractual arrangements to be set up with providers, patient and family.
Care Coordinator
Birmingham, AL · On-site
$18 - $24.25/hr
Utilization review activities may include prospective, concurrent, retrospective and appeals ... The plan of care calls for contractual arrangements to be set up with providers, patient and family.
Answers coverage questions and reviews policy forms * Analyze contractual insurance requirements and analyze client needs. * Verifies documentation received from Jr. AE/AE regarding new & renewal ...
New
Answers coverage questions and reviews policy forms * Analyze contractual insurance requirements and analyze client needs. * Verifies documentation received from Jr. AE/AE regarding new & renewal ...
New
Answers coverage questions and reviews policy forms * Analyze contractual insurance requirements and analyze client needs. * Verifies documentation received from Jr. AE/AE regarding new & renewal ...
New
Answers coverage questions and reviews policy forms * Analyze contractual insurance requirements and analyze client needs. * Verifies documentation received from Jr. AE/AE regarding new & renewal ...
New
Answers coverage questions and reviews policy forms * Analyze contractual insurance requirements and analyze client needs. * Verifies documentation received from Jr. AE/AE regarding new & renewal ...
Answers coverage questions and reviews policy forms * Analyze contractual insurance requirements and analyze client needs. * Verifies documentation received from Jr. AE/AE regarding new & renewal ...
Therapist
Owens Cross Roads, AL · On-site
The Master Level Therapist acts as a liaison with sponsoring agencies, including utilization review ... Medical, dental, vision, and life insurance after 60 days * Company provided Short Term and ...
Therapist
Owens Cross Roads, AL · On-site
The Master Level Therapist acts as a liaison with sponsoring agencies, including utilization review ... Medical, dental, vision, and life insurance after 60 days * Company provided Short Term and ...
RN Case Manager
Gadsden, AL · On-site
... utilization review, and helping patients navigate insurance and healthcare systems. Essential Duties and Responsibilities (includes, but not limited to): * Patient Assessment: evaluate patients ...
RN Case Manager
Gadsden, AL · On-site
... utilization review, and helping patients navigate insurance and healthcare systems. Essential Duties and Responsibilities (includes, but not limited to): * Patient Assessment: evaluate patients ...
RN Case Manager
Gadsden, AL · On-site
... utilization review, and helping patients navigate insurance and healthcare systems. Responsibilities Essential Duties and Responsibilities (includes, but not limited to): * Patient Assessment ...
RN Case Manager
Gadsden, AL · On-site
... utilization review, and helping patients navigate insurance and healthcare systems. Responsibilities Essential Duties and Responsibilities (includes, but not limited to): * Patient Assessment ...
RN Case Manager
Gadsden, AL · On-site
... utilization review, and helping patients navigate insurance and healthcare systems. Responsibilities Essential Duties and Responsibilities (includes, but not limited to): * Patient Assessment ...
RN Case Manager
Gadsden, AL · On-site
... utilization review, and helping patients navigate insurance and healthcare systems. Responsibilities Essential Duties and Responsibilities (includes, but not limited to): * Patient Assessment ...
RN Case Manager
Gadsden, AL · On-site
... utilization review, and helping patients navigate insurance and healthcare systems. Responsibilities Essential Duties and Responsibilities (includes, but not limited to): * Patient Assessment ...
RN Case Manager
Gadsden, AL · On-site
... utilization review, and helping patients navigate insurance and healthcare systems. Responsibilities Essential Duties and Responsibilities (includes, but not limited to): * Patient Assessment ...
RN Case Manager
Gadsden, AL · On-site
... utilization review, and helping patients navigate insurance and healthcare systems. Responsibilities Essential Duties and Responsibilities (includes, but not limited to): * Patient Assessment: e ...
RN Case Manager
Gadsden, AL · On-site
... utilization review, and helping patients navigate insurance and healthcare systems. Responsibilities Essential Duties and Responsibilities (includes, but not limited to): * Patient Assessment: e ...
Contractual Insurance Utilization Review information
What is the difference between Contractual Insurance Utilization Review vs Insurance Claims Adjuster?
| Aspect | Contractual Insurance Utilization Review | Insurance Claims Adjuster |
|---|---|---|
| Credentials | Certifications in healthcare or insurance review, such as URAC or AAPC | Adjuster licenses, certifications like AIC or CPCU |
| Work Environment | Healthcare facilities, insurance companies, or third-party review organizations | Insurance companies, claims offices, or independent agencies |
| Primary Focus | Assessing medical necessity and appropriateness of services | Evaluating insurance claims for coverage and settlement |
| Industry Usage | Common in health insurance and managed care | Common in property, casualty, and health insurance claims |
Contractual Insurance Utilization Review focuses on evaluating medical necessity, while Insurance Claims Adjusters handle claims processing and settlement. Both roles require industry-specific certifications and are integral to insurance operations, but they serve different functions within the insurance process.
What are the most commonly searched types of Insurance Utilization Review jobs in Alabama?
The most popular types of Insurance Utilization Review jobs in Alabama are:
What cities in Alabama are hiring for Contractual Insurance Utilization Review jobs?
Cities in Alabama with the most Contractual Insurance Utilization Review job openings:
Senior Director of Utilization Management (Nurse Practitioner)
Birmingham, AL • On-site
Full-time
Posted yesterday
New
NaphCare rating
6.4
Based on 49 frontline employees who took The Breakroom Quiz
644th of 891 rated healthcare providers
Job description
Overview
NaphCare has an excellent opportunity for a Senior Director of Utilization Management to join our team at our Corporate Headquarters office located in Birmingham, AL.
*This is an on-site position.
NaphCare is one of the largest providers of healthcare services to correctional facilities throughout the United States. NaphCare is a family owned, healthcare technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 36 years.
NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. Come join our growing team of 7,000 + employees!
The Senior Director of Utilization Management (Sr. UM) will provide leadership and oversight of utilization management processes across our correctional healthcare system. This individual must be a licensed Nurse Practitioner (NP), with correctional healthcare experience strongly preferred, who will supervise a team of UM nurses and NPs. The Sr. UM will ensure appropriate use of medical services, streamline clinical workflows, and uphold compliance with standards and contractual requirements.
Responsibilities
- Lead and oversee the Utilization Management (UM) program across multiple facilities.
- Supervise and mentor UM nurses and NPs, ensuring consistency and quality in reviews and decisions.
- Review and approve requests for specialty referrals, diagnostics, and procedures to ensure medical necessity and cost-effectiveness.
- Monitor UM trends and collaborate with clinical leaders to improve efficiency and outcomes.
- Serve as the primary clinical liaison between site teams, corporate leadership, and external partners regarding UM processes.
- Ensure compliance with NCCHC/ACA standards, contract requirements, and state/federal regulations.
- Contribute to quality improvement initiatives and reporting.
Qualifications
- Licensed Nurse Practitioner (NP) with active, unrestricted license.
- Correctional healthcare experience strongly preferred.
- Demonstrated expertise in Utilization Management and care coordination.
- Strong leadership and team management skills, with the ability to supervise clinical staff across multiple locations.
- Excellent communication, analytical, and decision-making skills.
- Familiarity with NCCHC/ACA standards and correctional healthcare regulations.
- Willingness to travel as needed.
Preferred Qualifications
- Experience leading utilization management programs at a system level.
- Background in quality improvement, risk management, or compliance.
- Proficiency with electronic health records and UM platforms.
NaphCare Benefits Package:
NaphCare offers competitive benefits including health, prescription, dental, vision, Employment Assistance Program (EAP) services, and 401(k). NaphCare offers term life insurance at no cost to the employee and also provides PTO, paid holidays and an array of voluntary benefits. Employees enrolled in our health insurance program receive prescriptions free of charge when filled at our in-house pharmacy or mail order program.
Want a better idea of what it’s like to work in correctional healthcare for the federal, state and local government?
- Life at NaphCare: Inside Correctional Healthcare: Care That Makes a Difference
- Life at NaphCare: Autonomy
- Life at NaphCare: Safety
- Life at NaphCare: Skill Building & Professional Development Opportunities
- Life at NaphCare - Life as a NaphCare Nurse Practitioner
- NaphCare - Life as an LPN - YouTube
About NaphCare
Sourced by ZipRecruiter
NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need. Be part of a world-class team of professionals who are revolutionizing correctional healthcare. NaphCare offers competitive compensation! Our full-time teammates have a top-notch benefits package, which includes medical, dental, vision, FREE prescriptions, flexible spending account, company-paid life and AD&D insurance with voluntary life and AD&D options, ST & LT disability, 401(k) company contribution, 20 days Paid Time Off, paid holidays, tuition assistance, employee referral bonuses, etc.
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Birmingham, AL, US
Year founded
1989