Remote * Benefits for eligible positions only include: generous paid time off, paid parental leave ... May prepare statistical analysis and utilization review reports as necessary. * Oversee and ...
Remote * Benefits for eligible positions only include: generous paid time off, paid parental leave ... May prepare statistical analysis and utilization review reports as necessary. * Oversee and ...
Remote Prior Authorization Pharmacist
Mobile, AL · Remote
$49.75 - $59.75/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Remote Prior Authorization Pharmacist
Mobile, AL · Remote
$49.75 - $59.75/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Remote Prior Authorization Pharmacist
Birmingham, AL · Remote
$50 - $60/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Remote Prior Authorization Pharmacist
Birmingham, AL · Remote
$50 - $60/hr
Review prior authorization requests for accuracy, appropriateness, and clinical necessity. * Apply ... Prior authorization, utilization management, or managed care preferred - retail or hospital ...
Appeals Pharmacist (Remote)
Mobile, AL · On-site +1
$48.75 - $59.50/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Appeals Pharmacist (Remote)
Mobile, AL · On-site +1
$48.75 - $59.50/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Appeals Pharmacist (Remote)
Birmingham, AL · On-site +1
$49 - $59.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Appeals Pharmacist (Remote)
Birmingham, AL · On-site +1
$49 - $59.75/hr
Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...
Lead operational governance activities across assigned Clubs, including creative review oversight ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements
Lead operational governance activities across assigned Clubs, including creative review oversight ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements
Account Manager, Enterprise
Birmingham, AL · On-site +1
Run quarterly business reviews with practice leadership using their own metrics: answer rates, hold ... Channel structured client feedback to product Location Remote (US) with approximately 25% travel to ...
Account Manager, Enterprise
Birmingham, AL · On-site +1
Run quarterly business reviews with practice leadership using their own metrics: answer rates, hold ... Channel structured client feedback to product Location Remote (US) with approximately 25% travel to ...
Account Manager, Enterprise
Birmingham, AL · On-site +1
Run quarterly business reviews with practice leadership using their own metrics: answer rates, hold ... Channel structured client feedback to product Location Remote (US) with approximately 25% travel to ...
Account Manager, Enterprise
Birmingham, AL · On-site +1
Run quarterly business reviews with practice leadership using their own metrics: answer rates, hold ... Channel structured client feedback to product Location Remote (US) with approximately 25% travel to ...
Care Manager (Hybrid-Remote)
Sylacauga, AL · On-site +1
Chart Review and Documentation * Conduct structured reviews of clinical records to assess service utilization, client engagement, and treatment plan compliance. * Document all findings and ...
Care Manager (Hybrid-Remote)
Sylacauga, AL · On-site +1
Chart Review and Documentation * Conduct structured reviews of clinical records to assess service utilization, client engagement, and treatment plan compliance. * Document all findings and ...
Legal Counsel - USA & Canada
Calvert, AL · On-site +1
If remote from Atlanta or anywhere else, monthly travel to Calvert, Alabama for 2-3 day stay ... Draft, review, and negotiate a wide range of procurement and buy-side agreements, including ...
Legal Counsel - USA & Canada
Calvert, AL · On-site +1
If remote from Atlanta or anywhere else, monthly travel to Calvert, Alabama for 2-3 day stay ... Draft, review, and negotiate a wide range of procurement and buy-side agreements, including ...
Develop and lead a high-performance remote field-based sales team and strong accountability culture ... Conduct structured performance reviews and individual coaching to accelerate team development and ...
Develop and lead a high-performance remote field-based sales team and strong accountability culture ... Conduct structured performance reviews and individual coaching to accelerate team development and ...
Develop and lead a high-performance remote field-based sales team and strong accountability culture ... Conduct structured performance reviews and individual coaching to accelerate team development and ...
Develop and lead a high-performance remote field-based sales team and strong accountability culture ... Conduct structured performance reviews and individual coaching to accelerate team development and ...
Develop and lead a high-performance remote field-based sales team and strong accountability culture ... Conduct structured performance reviews and individual coaching to accelerate team development and ...
Develop and lead a high-performance remote field-based sales team and strong accountability culture ... Conduct structured performance reviews and individual coaching to accelerate team development and ...
Develop and lead a high-performance remote field-based sales team and strong accountability culture ... Conduct structured performance reviews and individual coaching to accelerate team development and ...
Develop and lead a high-performance remote field-based sales team and strong accountability culture ... Conduct structured performance reviews and individual coaching to accelerate team development and ...
Develop and lead a high-performance remote field-based sales team and strong accountability culture ... Conduct structured performance reviews and individual coaching to accelerate team development and ...
Quick apply
Develop and lead a high-performance remote field-based sales team and strong accountability culture ... Conduct structured performance reviews and individual coaching to accelerate team development and ...
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Support compliance reviews and audits * Interpret licensing terms and requirements Automation ...
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Support compliance reviews and audits * Interpret licensing terms and requirements Automation ...
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Support compliance reviews and audits * Interpret licensing terms and requirements Automation ...
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Support compliance reviews and audits * Interpret licensing terms and requirements Automation ...
Chart Review and Documentation * Conduct structured reviews of clinical records to assess service utilization, client engagement, and treatment plan compliance. * Document all findings and ...
Chart Review and Documentation * Conduct structured reviews of clinical records to assess service utilization, client engagement, and treatment plan compliance. * Document all findings and ...
Project Manager
AL · On-site +1
$80K - $100K/yr
Huntsville, AL/Remote SOC Code: 13-1082 Salary*: $80,000-$100,000 *Dependent upon qualifications ... up on and reviews meeting minutes recorded by another team member. * Provide strategy and ...
Project Manager
AL · On-site +1
$80K - $100K/yr
Huntsville, AL/Remote SOC Code: 13-1082 Salary*: $80,000-$100,000 *Dependent upon qualifications ... up on and reviews meeting minutes recorded by another team member. * Provide strategy and ...
National Sales Manager
AL · Remote
The role is a remote position; location base will be reviewed as this position covers all regions ... Enhance data utilization capabilities and enable stronger data led decision making in setting ...
National Sales Manager
AL · Remote
The role is a remote position; location base will be reviewed as this position covers all regions ... Enhance data utilization capabilities and enable stronger data led decision making in setting ...
Remote Utilization Review information
What are the key skills and qualifications needed to thrive in the Remote Utilization Review position, and why are they important?
To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.
What does a typical day look like for someone in a Remote Utilization Review role?
A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.
What is a Remote Utilization Review job?
A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.
What are the most commonly searched types of Utilization Review jobs in Alabama? The most popular types of Utilization Review jobs in Alabama are:
What are popular job titles related to Remote Utilization Review jobs in Alabama? For Remote Utilization Review jobs in Alabama, the most frequently searched job titles are:
- Remote Utilization Review Rn
- Utilization Review Nurse
- Remote Cvs Utilization Management Nurse
- Weekend Appeals Nurse Remote
- No Experience Utilization Review Nurse
- Remote Prior Authorization Nurse
- Medical Review Nurse
- Weekend Physician Advisor Utilization Review
- Registered Nurse Utilization Review
- Remote Utilization Management
What job categories do people searching Remote Utilization Review jobs in Alabama look for? The top searched job categories for Remote Utilization Review jobs in Alabama are:
- Lpn Utilization Review
- Remote Cigna Utilization Review Nurse
- Remote Utilization Review Nurse Practitioner
- Remote Aetna Utilization Review Nurse
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- Remote Preservice Review Nurse
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- Fulltime Cigna Utilization Review Nurse
What cities in Alabama are hiring for Remote Utilization Review jobs? Cities in Alabama with the most Remote Utilization Review job openings:
Other
Medical, PTO
Posted 12 days ago
Job description
Position Overview
- Department: Utilization Management
- Schedule: M-F Days
- Work Location: Remote
- 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:
- Registered Nurse credentialed from the Alabama Board of Nursing obtained prior to hire date or jobtransfer date required.
Education:
- Diploma from an accredited school/college of nursing and required professional licensure at time of hire.
No additional preferences.
About UAB St. Vincent'sUAB 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.
Employment Type: OTHER