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Utilization Review Case Manager Jobs in Alabama (NOW HIRING)

Prime Healthcare

RN Case Manager

Gadsden, AL

An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...

Prime Healthcare

RN Case Manager

Gadsden, AL · On-site

An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: m onitor the use of hospital resources and services to ensure appropriate care ...

Encompass Health Corporation

Case Manager

Pelham, AL · On-site

$18.25 - $23.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Encompass Health

Case Manager

Montgomery, AL

$19.75 - $25.50/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Case Manager

Birmingham, AL

$18.75 - $24.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...

Encompass Health

Case Manager

Phenix City, AL

$18 - $23.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Alabama

Utilization Review Case Manager information

See Alabama salary details

$15

$33

$54

How much do utilization review case manager jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for utilization review case manager in Alabama is $33.07, according to ZipRecruiter salary data. Most workers in this role earn between $26.78 and $34.86 per hour, depending on experience, location, and employer.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

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

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
What are popular job titles related to Utilization Review Case Manager jobs in Alabama? For Utilization Review Case Manager jobs in Alabama, the most frequently searched job titles are:
What job categories do people searching Utilization Review Case Manager jobs in Alabama look for? The top searched job categories for Utilization Review Case Manager jobs in Alabama are:
What cities in Alabama are hiring for Utilization Review Case Manager jobs? Cities in Alabama with the most Utilization Review Case Manager job openings:
Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Alabama as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $68,787 per year, or $33.1 per hour.

Utilization Review Care Manager - Registered Nurse/RN

DCH Health System

Tuscaloosa, AL • On-site

Other

Posted 29 days ago

DCH Health System rating

7.0

Company rating: 7.0 out of 10

Based on 19 frontline employees who took The Breakroom Quiz

Job description

Overview
Evaluates patients for appropriateness of admission type and setting, utilizing a combination of clinical information and InterQual guidelines. The Utilization Review Nurse utilizes clinical knowledge to support the coordination and documentation and communication of medical services and/or benefits. The Utilization Nurse also serves on the liaison between the physicians, patients, payers and care managers regarding termination of benefits, denial notification, and expedited appeals. Has access to highly sensitive, confidential information.
Responsibilities
  1. Evaluates medical records for appropriateness of admission status utilizing a combination of clinical information, screening criteria, and third party information. Collaborates with business office, care managers, attending physicians, and physician advisors as needed
  2. Conducts self-auditing of medical records for status accuracy and provides peer consultation regarding cases in which patients are failing to progress and/or experiencing significant deviation from the plan of care.
  3. Educates staff and physicians about managed care principles, observation status, discharge planning, and reimbursement rules.
  4. Works with Patient Registration\Financial Counselor (s) to identify correct insurance source and proper billing.
  5. Verifies patient admission information for each assigned patient within 24 hours of patient's admission (next business day)
  6. Collaborates with the Case Manager to identify referrals to Financial Counselors.
  7. Negotiates resolution disagreements over the need for acute hospital level of care with the insurer.
  8. Collaborates with social workers for patients with complex, clinical, financial and psycho-social needs.
  9. Reviews physician orders and patient progression and intervenes with care coordination as needed. Collaborates with other departments to eliminate barriers, as necessary.
  10. Builds trusting relationships with attending physician, patient and/or family and other members of the healthcare team. Establishes a caring relationship with patients and their caregivers, promotes patient engagement and guides patients/families through the transition phase
  11. In accordance with established clinical guidelines/standards of care establishes a comprehensive care transition plan and will organize, secure, integrate and modify resources necessary to meet the goals stated in the assessment plan.
  12. Identifies Potential Avoidable Days per department policy.
  13. Gathers information for statistical monitors, plus special projects within the Care Management Department.
  14. Maintains records in a complete, detailed, and orderly manner.
  15. Updates and documents in Midas, pertinent clinical information by utilizing screening criteria and assigns next review date.
  16. Responsible to support and participate in department strategies and efforts focused on improving length of stay (LOS) and reduction of avoidable readmissions.
  17. Responsible to support and participate in department strategies and efforts focused on improving clinical documentation by physicians.
  18. Is knowledgeable of hospital mission, vision, and values and performs in a manner to support them.
  19. Identifies and reports Quality and Risk Management concerns.
DCH Standards:
  • Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
  • Performs compliance requirements as outlined in the Employee Handbook.
  • Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
  • Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
  • Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
  • Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
  • Requires use of electronic mail, time and attendance software, learning management software and intranet.
  • Must adhere to all DCH Health System policies and procedures.
  • All other duties as assigned.
Qualifications
  1. Anyone hired after July, 2011 must meet the following:
  2. Minimum of Registered Nurse with current Alabama license.
  3. Minimum 2 years experience as an RN
  4. Minimum of at least 2 years as care management and/or utilization management experience preferred.
  5. Minimum of 2 years of Med Surgical experience required; Utilization Review experience preferred.
  6. Expected to work under minimal management supervision
  7. Efficient use of basic computer skills
  8. Ability to multi task, prioritize and effectively adapt to a fast paced changing environment
  9. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the phone and typing on the computer.
  10. Work requires the ability to perform close inspection of computer generated documents as well as a PC monitor.
  11. Typical office working environment with productivity and quality expectations.
  12. Ability to establish priorities, meets deadlines, and maintains proper productivity.
  13. Ability to form positive, collaborative relationships with hospital staff, patients, families and payers.
  14. Ability to problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge.
  15. Ability to effectively negotiate with internal and external providers of patient care services.
  16. Ability to develop leadership skills and to serve as a role model for clinical staff.
  17. Ability to lead and actively participate in multidisciplinary teams.
  18. Ability to work independently or within a team structure.
  19. Excellent interpersonal skills, communication style and organization.
  20. Must be able to read, write legibly, speak, and comprehend English.

Working Conditions:
WORK CONTEXT
  • Ability to form positive, collaborative relationships with physicians, colleagues, hospital staff, patients, families, and external contacts.
  • Ability to provide guidance and direction to subordinates, including performance standards and monitoring performance.
  • Ability to encourage and build mutual trust, respect, and cooperation among team members.
  • Ability to communicate with people outside the organization and represent the organization to the public, government, and other external sources.
  • Ability to work independently or within a team structure.
  • May be exposed to environmental cleaning chemicals
PHYSICAL FACTORS
  • Requires Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
  • Ability to tolerate prolonged periods of sitting or standing and/or walking.
  • Ability to reach reasonable distances to handle equipment.
  • Good manual and finger dexterity.
  • Must be able to perform the duties with or without reasonable accommodation.
  • Hearing and vision must be normal or corrected to within normal range.
  • Physical presence onsite is essential.

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