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Insurance Utilization Reviewer Jobs in Alabama (NOW HIRING)

Opp Health And Rehabilitation LLC

Unit Manager - RN

Opp, AL · On-site

$35 - $46.25/hr

... utilization review activities. * Receives physicians' instructions regarding resident care and ... Dental Insurance, Life Insurance, Vision Insurance * 401K with company match * Paid Holidays and ...

Athens Health and Rehabilitation LLC

Unit Manager - RN

Opp, AL · On-site

$35 - $46.25/hr

... utilization review activities. * Receives physicians' instructions regarding resident care and ... Dental Insurance, Life Insurance, Vision Insurance * 401K with company match * Paid Holidays and ...

Gianteagle

$15.75 - $19.50/hr

Ensure proper documentation for transmitting information to insurance companies, reviewing profiles for appropriate billing choices. * Alert pharmacists appropriately for drug utilization reviews ...

NHS Management, LLC

RN Unit Manager (8a-5p)

Jacksonville, AL

$37.25 - $49.25/hr

... utilization review activities. * Receives physicians' instructions regarding resident care and ... Dental Insurance, Life Insurance, Vision Insurance * 401K with company match * Paid Holidays and ...

NHS Management, LLC

Unit Manager RN (7a-3p)

Madison, AL · On-site

$37.50 - $49.50/hr

... utilization review activities. * Receives physicians' instructions regarding resident care and ... Dental Insurance, Life Insurance, Vision Insurance * 401K with company match * Paid Holidays and ...

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Insurance Utilization Reviewer information

What are the key skills and qualifications needed to thrive as an Insurance Utilization Reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are some common challenges faced by Insurance Utilization Reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What are Insurance Utilization Reviewers?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.
What are popular job titles related to Insurance Utilization Reviewer jobs in Alabama? For Insurance Utilization Reviewer jobs in Alabama, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Reviewer jobs in Alabama look for? The top searched job categories for Insurance Utilization Reviewer jobs in Alabama are:
What cities in Alabama are hiring for Insurance Utilization Reviewer jobs? Cities in Alabama with the most Insurance Utilization Reviewer job openings:
Insurance Utilization Reviewer jobs near you

Registered Nurse ( RN ) Weekend Supervisor

Cordova Health And Rehabilitation LLC

Cordova, AL

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 24 days ago

Job description

The Good Stuff! At a Glance!
  1. $15,000 Sign-On Bonus (Full-Time)
  2. Leadership Opportunity | Consistent Weekend Schedule
  3. Competitive RN Pay
  4. Blue Cross Blue Shield Health & Dental Insurance
  5. Vision Insurance
  6. Life Insurance
  7. Paid Time Off (PTO) & Paid Holidays
  8. 401(k) Retirement Savings Plan with Company Match


Cordova Health and Rehabilitation, where compassion, teamwork, and purpose come together to make every day meaningful.


Position Summary: Registered Nurse ( RN ) Weekend Supervisor

The Registered Nurse (RN) Weekend Supervisor serves as the clinical leader responsible for overseeing resident care operations on the weekend rotation.


Qualifications:

  1. Current R.N. license by State required with experience in the long-term care or working with the geriatric population preferred.
  2. Must have at least two years of nursing experience and one year supervisory experience.
  3. Clerical ability is necessary to read reports and utilize data accurately for other purposes.
  4. Skill in organizing and planning programs and managing personnel to provide nursing services for residents.
  5. Ability to plan and direct the department, coordinating with other departments.


Key Responsibilities:

  1. Assists in maintaining resident care standards by supervising and directing activities of subordinate nurses engaged in quality assurance, infection control, and utilization review activities.
  2. Receives physicians' instructions regarding resident care and ensures that orders are transmitted to other units as needed.
  3. Oversees delegation of nursing and other therapeutic procedures to other level professionals and paraprofessional associates.
  4. Makes regular patient rounds to observe and assess residents’ physical conditions and behaviors, evaluates the quality of care provided, and ensures proper documentation of treatment and nursing observations.


Benefits:

  1. Competitive wages for Registered Nurses (RN)
  2. Blue Cross Blue Shield Health and Dental Insurance
  3. Vision Insurance
  4. Life insurance
  5. Paid Time Off (PTO) and Paid Holidays
  6. 401(k) Retirement Savings Plan with Company Match



Professional Care. Purposeful Leadership. Lasting Impact.


We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

"Our Family Caring For Yours"