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Remote Utilization Review Jobs in Alabama (NOW HIRING)

Bcbsa

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

Transform9

Senior Customer Success Manager

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 ...

Transform9

Senior Customer Success Manager

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 ...

Outokumpu

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 ...

Autocar, LLC

Vice President of Sales

Birmingham, AL · Remote

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 ...

GVW Group, LLC

Vice President of Sales

Birmingham, AL · Remote

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 ...

Autocar, LLC

Vice President of Sales

Birmingham, AL · Remote

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 ...

Autocar, LLC

Vice President of Sales

Birmingham, AL · Remote

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 ...

Kodama Systems Inc.

Head of Commercial

Birmingham, AL · Remote

Head of Commercial Full Time | Remote, based in the Southeastern United States | 25%-50% travel ... utilization, operating costs, safety, and the ability to scale logging crews. * Represent Kodama at ...

Summit 7 Systems

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 ...

DaVita, Inc.

Florence, AL - Hybrid/Remote (ESKD/CKD) This is a hybrid/remote , field based role requiring a dedicated home office and the ability to travel to meet business and patients needs, including team and ...

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Remote Utilization Review information

What is a remote utilization review?

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 does a remote utilization review do?

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 are the key skills and qualifications needed to thrive in remote utilization review?

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 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:

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:

What cities in Alabama are hiring for Remote Utilization Review jobs?

Cities in Alabama with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Alabama as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Director, Trade Client Relations

Bcbsa

On-site, Remote

$155K - $175K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 27 days ago

Job description

Synergie Medication Collective is a new medication contracting organization founded by a group of Blue Cross and Blue Shield affiliated companies to serve both Blues and select independent health plans. Synergie is focused on improving affordability and access to costly medical benefit drugs - ones that are injected or infused by a health care professional in a clinical setting - for nearly 100 million Americans. The Trade Client Strategy Director liaises with Synergie Participants and manages clinical policies to comply with manufacturer contracts, implements Trade strategies and initiatives, and collaborates with and supports Synergie's Client Relations team for Trade related inquiries. This includes medical and pharmacy drug policies, cross benefit management, and rebate qualification for manufacturer contracts. This position will establish and maintain cross functional partnerships with internal teams to drive the identification, development and successful execution of Synergie's rebate programs. This position will be the primary Trade point of contact for Synergie's Participant facing activities and will support clinical decision making at the Participant level to comply with manufacturer contracts.

Primary Job Functions

  • Consult with Client Relations team on Trade related inquiries, initiatives, and opportunity pull through with Participants

  • Understands downstream impact of rebate and formulary strategy and can convey appropriate messaging to health plan participants for adoption of said strategies and policies

  • Has working knowledge of PBM operations and understanding of drug and UM strategy and policy implementation

  • Has experience in reading and interpreting pharmaceutical manufacturer drug contracts and understanding how to align terms and conditions and translate into UM policy and criteria

  • Manage medical and pharmacy clinical policies with Participants to ensure manufacturer contract compliance

  • Collaborate and support Client Relations team for Trade related inquiries from Participants

Partner with the following stakeholders:

  • Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy decisions, medical policy and formulary compliance, drug share shift and utilization management strategies

  • Client Relations - Serve as Trade's primary point of contact for all Participant questions on Trade initiatives and manufacturer contracts and escalate issues as needed to Trade's leadership

  • Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

  • Invoicing Team - Maintain current library of Participant medical and pharmacy policies and support Invoicing team with manufacturer inquiries regarding clinical policies

  • Product Team - Provide medical policy support for manufacturer related contracts including, but not limited to, cell and gene therapies and other outcomes programs

Education, Experience, and Certification

  • Pharmacy degree and Pharm D. preferred

  • 5-7 years of related work experience in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical contracting, client relations, or analytical contracting

  • Must be eligible to work in the United States without need for work visa or residency sponsorship

  • Excellent verbal and written presentation skills

  • Ability to establish rapport and build relationships at all levels within an organization

  • Practical application of clinical data to drive financial value

  • Strong business and financial acumen, with advanced proficiency in Excel and PowerPoint

Knowledge, Skills, and Abilities

  • Pharmacy residency training or equivalent experience

  • Experience within the PBM industry, Medicaid, Medicare, and health plans

  • Experience with contract language and risk mitigation concepts

Travel Requirements: Up to 10% of the time.

Work is generally performed in a remote setting.

#LI-Remote

$155,000.00 - $175,000.00

This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.This job is also eligible for annual bonus incentive pay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

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