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Remote Rn Utilization Review Nurse Jobs in Alabama

CVS Health

Case Manager, Registered Nurse

Montgomery, AL · Remote

$54K - $155K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

Varsity Tutors

NCLEX-RN Tutor

Tuscaloosa, AL · Remote

$40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Birmingham, AL · Remote

$40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Montgomery, AL · Remote

$40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Huntsville, AL · Remote

$40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

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Remote Rn Utilization Review Nurse information

What is the difference between Remote Rn Utilization Review Nurse vs Remote Rn Case Manager?

AspectRemote Rn Utilization Review NurseRemote Rn Case Manager
CertificationsRN license, possibly UR or CCM certificationRN license, CCM or other case management certification
Work EnvironmentReviewing medical records, insurance guidelines, and authorizationsCoordinating patient care, discharge planning, and resource management
Employer & Industry UsageHealth insurance companies, third-party administratorsHospitals, health plans, healthcare providers

Remote Rn Utilization Review Nurses primarily evaluate medical necessity for insurance approvals, focusing on documentation and guidelines. In contrast, Remote Rn Case Managers coordinate patient care, discharge planning, and resource allocation. Both roles require RN licensure and related certifications but differ in daily tasks and work focus.

What is a Remote RN Utilization Review Nurse?

A Remote RN Utilization Review Nurse is a registered nurse who evaluates medical records and healthcare services from a remote location to ensure that patients receive appropriate, necessary, and cost-effective care. They review treatment plans, check for compliance with insurance and healthcare guidelines, and often work with healthcare providers, insurance companies, and patients to coordinate care. This role typically involves assessing the medical necessity of procedures, authorizing services, and helping prevent unnecessary treatments or hospitalizations.

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

To thrive as a Remote RN Utilization Review Nurse, you need an active RN license, strong clinical knowledge, and experience in case management or utilization review. Proficiency with healthcare review software, electronic health records (EHRs), and familiarity with insurance guidelines or regulatory requirements is vital. Excellent communication, critical thinking, and time management skills distinguish top performers in remote settings. These skills enable nurses to make accurate, timely decisions about patient care while ensuring compliance and efficient resource utilization.

What are some common challenges faced by Remote RN Utilization Review Nurses, and how can they be addressed?

Remote RN Utilization Review Nurses often encounter challenges such as managing large caseloads, maintaining effective communication with interdisciplinary teams, and staying updated with ever-changing insurance guidelines. Balancing productivity expectations while ensuring thorough case reviews can be demanding. To address these challenges, nurses can utilize robust organizational tools, participate in ongoing training sessions, and leverage regular virtual meetings to stay connected with colleagues and supervisors, ensuring both efficiency and high-quality patient care.
What are the most commonly searched types of Rn Utilization Review Nurse jobs in Alabama? The most popular types of Rn Utilization Review Nurse jobs in Alabama are:
What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Alabama? For Remote Rn Utilization Review Nurse jobs in Alabama, the most frequently searched job titles are:
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Remote Rn Utilization Review Nurse jobs near you

RN - Registered Nurse - Utilization Review

UAB St. Vincent's

Birmingham, AL • Remote

Other

Medical, PTO

Posted 3 days ago

Job description

Position Overview
  • Department: Utilization Management
  • Schedule: M-F 8am- 5pm
  • Work Location: Remote
  • Benefits for eligible positions only include: generous paid time off, paid parental leave, Associate Assistance Program, Tuition Reimbursement Program, and more
What You Will Do
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.
What You Will Need
Licensure / Certification / Registration:
  • 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.

Additional Preferences
No additional preferences.
About UAB St. Vincent's
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.

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