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Remote Insurance Utilization Review Jobs in Alabama

Deloitte

Epic Tapestry Consultant

Huntsville, AL · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry ... Insurance, Telecom, Media and Energy & Resources. Our OTT team brings clients the knowledge of ...

Deloitte

Epic Tapestry Specialist

Huntsville, AL · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry ... Insurance, Telecom, Media and Energy & Resources. Our OTT team brings clients the knowledge of ...

Deloitte

Epic Tapestry Consultant

Birmingham, AL · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry ... Insurance, Telecom, Media and Energy & Resources. Our OTT team brings clients the knowledge of ...

Aprio

Senior Director, Resource Management

Birmingham, AL · On-site +1

$225K - $300K/yr

Analyze trends in utilization, availability, backlog, pipeline, and seasonal demand to drive timely ... Perks/Benefits we offer for full-time team members: - Medical, Dental, and Vision Insurance on the ...

Deloitte

Epic Tapestry Specialist

Birmingham, AL · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry ... Insurance, Telecom, Media and Energy & Resources. Our OTT team brings clients the knowledge of ...

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Remote Insurance Utilization Review information

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What are remote insurance utilization review jobs?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.
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 are popular job titles related to Remote Insurance Utilization Review jobs in Alabama? For Remote Insurance Utilization Review jobs in Alabama, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Alabama look for? The top searched job categories for Remote Insurance Utilization Review jobs in Alabama are:
What cities in Alabama are hiring for Remote Insurance Utilization Review jobs? Cities in Alabama with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you
LPN Care Manager (Hybrid Remote) (Baldwin, Mobile & Washington Counties, AL)

LPN Care Manager (Hybrid Remote) (Baldwin, Mobile & Washington Counties, AL)

AltaPointe Health

AL • On-site, Remote

Full-time

Posted 5 days ago

AltaPointe Health rating

7.0

Company rating: 7.0 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

Job description

Responsibilities
Primary Job Functions:
Clinical:
  • Chart Review and Documentation
    • Conduct structured reviews of clinical records to assess service utilization, client engagement, and treatment plan compliance.
    • Document all findings and coordination efforts in the electronic health record using the Care Manager System.
    • Identify gaps in care, missed services, or follow-up needs and take appropriate action.
  • Care Coordination
    • Coordinate physical, behavioral, and social health services across internal programs and external providers.
    • Facilitate client access to community-based services such as housing, benefits, employment supports, and substance use care.
    • Ensure referrals are generated, tracked, and closed with appropriate documentation.
  • Hospital Discharge and Transition Support
    • Conduct follow-up calls within 24 hours of psychiatric or medical hospital discharges.
    • Confirm follow-up appointments are scheduled, and discharge instructions are supported and understood.
    • Notify care team members of transitions and facilitate continuity of care.
  • Service Monitoring and Engagement
    • Monitor client attendance at therapy, psychiatry, and medical appointments.
    • Address patterns of disengagement, such as missed appointments, and initiate outreach or peer support referrals.
    • Review PHQ-9 and other screening tools to track clinical progress and inform care needs.
  • Referral and Linkage Management
    • Create, follow up, and close referrals in the Care Manager System.
    • Communicate with service providers to confirm that referrals were completed and appointments attended.
    • Resolve barriers such as transportation, insurance, or documentation needs.
  • Risk Identification and Response
    • Monitor client risk levels and report any significant changes to the treatment team.
    • Support crisis response planning by facilitating communication across care team members and community resources.
  • Treatment Plan Support
    • Assist with treatment plan implementation by ensuring services align with identified goals and timelines.
    • Coordinate updates to the treatment plan as client needs or engagement levels change.
  • Ongoing Caseload Management
    • Manage assigned client caseloads, respond to alerts, and complete scheduled reviews as outlined in care protocols.
    • Participate in team huddles and interdisciplinary case discussions.
  • Compliance and Reporting
    • Ensure documentation meets agency, Medicaid, and CCBHC standards.
    • Maintain timely and accurate entries in line with quality assurance requirements.
  • Productivity Standard
    • Care Managers are expected to review an average of 8-10 charts per day as they build familiarity with the process and complete full chart reviews.
    • Once training is completed and review skills are developed, productivity will increase to 15-20 chart reviews per day, depending on chart complexity, and new patient chart reviews.
    • Documentation of reviews must be completed daily to ensure timely follow-up and coordination of care.

Supervision and Consultation:
  • Seeks supervision and consultation as needed.
  • Accepts and employs suggestions for improvement.
  • Actively works to enhance care management skills

Clinical Record Keeping:
  • Documents interactions with patients and chart reviews.
  • Documents within Care Manager appropriate follow up and provision of linkage to services.

Courteous and respectful attitudes towards patients, visitors, and co-workers:
  • Treats patients with care, dignity, and compassion.
  • Respects patient's privacy and confidentiality.
  • Is pleasant and cooperative with others.
  • Personal values don't inhibit ability to relate and care for others.
  • Is sensitive to the patient's needs, expectations, and individual differences.

Caseload Management:
  • Effectively manages caseload based on patient needs and staffs with supervisor regularly.

Administrative and Other Related Duties as Assigned:
  • Actively participates in Performance Improvement activities.
  • Actively participates in AltaPointe committees as required.
  • Follows AltaPointe policies and procedures
  • Attends required in-service training and other workshops, trainings.

Qualifications
Minimum Qualifications:
Education:
Bachelor's degree in a behavioral health, human services, nursing, public health, or related field is preferred -or- High School diploma or equivalent and 4 years of experience in behavioral health, care coordination, case management, or related healthcare service delivery.
Experience:
Minimum of 2 years of experience in behavioral health, care coordination, case management, or related healthcare service delivery. Experience with high-need populations (SMI, SED, SUD) strongly preferred.
Skills and Competencies:
  • Strong knowledge of behavioral health systems, including mental health, substance use, and social determinants of health.
  • Proficiency in navigating and documenting within electronic health records (EHR), including coordination systems like Avatar or equivalent.
  • Experience with treatment planning, interagency coordination, and client engagement.
  • Strong organizational and communication skills, including ability to document accurately and follow up on tasks.
  • Ability to work independently and as part of an interdisciplinary team.

Other Requirements:
  • Valid driver's license and reliable transportation may be required based on program location.
  • Ability to pass background checks and credentialing per agency standards.

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