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Remote Utilization Review Manager Jobs in Sylacauga, AL

ABB

Group Account Manager

Alexander City, AL · Remote

$163K - $261K/yr

Remote {#LI-Remote} Your role and responsibilities: * Drives strategic account planning, sales ... to review the plan of a particular ABB facility between the hours of 9:00 A.M. - 5:00 P.M. EST ...

ABB

Utility Sales Support

Alexander City, AL · Remote

$17.75 - $23.25/hr

... management with local business units and other ABB groups. Additionally, the role will expand to ... While this is a remote position, candidates must be located in the United States. You will be ...

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Sylacauga, AL

Remote Utilization Review Manager information

See Sylacauga, AL salary details

$31.8K

$74.2K

$136.5K

How much do remote utilization review manager jobs pay per year?

As of Sep 3, 2026, the average yearly pay for remote utilization review manager in Sylacauga, AL is $74,166.00, according to ZipRecruiter salary data. Most workers in this role earn between $48,500.00 and $89,200.00 per year, depending on experience, location, and employer.

What is a remote utilization review manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a remote utilization review manager?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.

What are some common challenges faced by a remote utilization review manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

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

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What are popular job titles related to Remote Utilization Review Manager jobs in Sylacauga, AL?

For Remote Utilization Review Manager jobs in Sylacauga, AL, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Manager jobs in Sylacauga, AL look for?

The top searched job categories for Remote Utilization Review Manager jobs in Sylacauga, AL are:

What cities near Sylacauga, AL are hiring for Remote Utilization Review Manager jobs?

Cities near Sylacauga, AL with the most Remote Utilization Review Manager job openings:

Remote Utilization Review Manager jobs near you

Care Manager (Hybrid-Remote)

AltaPointe Health

Sylacauga, AL • On-site, Remote

Full-time

Re-posted 16 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 dedicate the majority of their workday to direct patient care coordination activities. Productivity expectations are as follows:
      • Care Managers will spend 80-90% of their time on patient care coordination, which includes chart reviews, outreach attempts, care coordination tasks, referral management, documentation, and follow-up.
      • During the initial training period, Care Managers will focus on building proficiency with workflows, documentation standards, and chart review processes. During this time, the number of charts reviewed per day may vary based on learning needs and case complexity.
      • Once fully trained and able to conduct efficient and thorough chart reviews, Care Managers will be expected to maintain a consistent workflow that aligns with spending 80-90% of time on patient care coordination tasks.
      • Daily Responsibilities: Each day, Care Managers are expected to:
        • Fully work all Hospital/ED/BHCC follow-ups assigned to them.
        • Complete all missed appointment follow ups.
        • Work referrals in order of patient risk, ensuring high risk patients are prioritized, followed by moderate-high risk, and then moderate- and low-risk referrals.
      • Documentation must be completed daily to support timely follow-up, continuity, and closed-loop care coordination.

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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