Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Supervises activities and functions related to ancillary team performance related discharge planning, utilization * management/ denials, department performance improvement, hospital committees ...
Supervises activities and functions related to ancillary team performance related discharge planning, utilization * management/ denials, department performance improvement, hospital committees ...
Supervises activities and functions related to ancillary team performance related discharge planning, utilization * management/ denials, department performance improvement, hospital committees ...
Supervises activities and functions related to ancillary team performance related discharge planning, utilization * management/ denials, department performance improvement, hospital committees ...
Supervises activities and functions related to ancillary team performance related discharge planning, utilization * management/ denials, department performance improvement, hospital committees ...
Supervises activities and functions related to ancillary team performance related discharge planning, utilization * management/ denials, department performance improvement, hospital committees ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Provide case management and/or consultation for complex cases. * Assist departmental staff with ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
Three years' experience in case management or utilization management preferred. Highlands Medical Center is a 170-bed hospital located in Scottsboro, offering a wide variety of emergency, inpatient ...
Three years' experience in case management or utilization management preferred. Highlands Medical Center is a 170-bed hospital located in Scottsboro, offering a wide variety of emergency, inpatient ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
Utilization Management supporting medical necessity and denial prevention * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care ...
Utilization Management supporting medical necessity and denial prevention * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care ...
Utilization Management supporting medical necessity and denial prevention * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care ...
Utilization Management supporting medical necessity and denial prevention * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care ...
Utilization Management supporting medical necessity and denial prevention * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care ...
Utilization Management supporting medical necessity and denial prevention * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care ...
Utilization Management supporting medical necessity and denial prevention * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care ...
Utilization Management supporting medical necessity and denial prevention * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care ...
American Traveler is hiring an experienced RN Case Manager with a CA RN license and 5+ years of ... experience with utilization review including admission criteria, appeals and denials, and ...
American Traveler is hiring an experienced RN Case Manager with a CA RN license and 5+ years of ... experience with utilization review including admission criteria, appeals and denials, and ...
Manager Utilization Management information
What are the key skills and qualifications needed to thrive as a manager utilization management?
To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.
What is the difference between Manager Utilization Management vs Utilization Review Nurse?
| Aspect | Manager Utilization Management | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, often with management or utilization review certifications | RN, with certifications in utilization review or case management |
| Work Environment | Supervises teams, manages policies, oversees utilization review processes | Performs patient chart reviews, assesses medical necessity, collaborates with providers |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare organizations |
| Search & Comparison Intent | Yes | Yes |
While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.
What are some common challenges faced by a manager utilization management, and how can they effectively address them?
Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.
What does a manager utilization management do?
A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the most commonly searched types of Utilization Management jobs in Alabama?
The most popular types of Utilization Management jobs in Alabama are:
What are popular job titles related to Manager Utilization Management jobs in Alabama?
For Manager Utilization Management jobs in Alabama, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Alabama look for?
The top searched job categories for Manager Utilization Management jobs in Alabama are:
What cities in Alabama are hiring for Manager Utilization Management jobs?
Cities in Alabama with the most Manager Utilization Management job openings:
Per diem
Medical, PTO
Posted 24 days ago
Job description
- Department: Utilization Review
- Schedule: PRN Days
- Work Location: UAB ST Vincent's Birmingham
- Benefits for eligible positions only include: generous paid time off, paid parental leave, Associate Assistance Program, Tuition Reimbursement Program, and more
Provide health care services regarding admissions, case management, discharge planning and utilization review.
- Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.
- Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
- Assess and coordinate discharge planning needs with healthcare team members.
- May prepare statistical analysis and utilization review reports as necessary.
- Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
Licensure / Certification / Registration:
- Licensed Associate Professional Registered Nurse credentialed from the Alabama Board of Nursing
obtained prior to hire date or job transfer date required.
Education:
- Diploma from an accredited school/college of nursing and required professional licensure at time of hire.
- One Year of Experience is required
No additional preferences.
UAB St. Vincent’s, a proud part of UAB Medicine, is a trusted provider of health care, serving Alabama for more than 125 years. With five hospitals and numerous clinics, we're a health care community deeply rooted in compassion, service, and respect for all, guided by the rich legacy of the St. Vincent’s name. We're committed to extending kindness and personalized care to patients, their families, and each other. We address the physical, psychological, social, and spiritual needs of our patients. We believe in the power of teamwork and unity, and foster a collaborative spirit among our more than 4,800 employees. As one of Alabama’s best hospitals as recognized by U.S. News & World Report, improving the health and lives of those we serve is at the heart of our mission. Join us in continuing our legacy of service and healing in central Alabama, where we can make a lasting impact together.