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Utilization Review Case Manager Jobs in Mobile, AL

WJM Professional Services LLC

Optometrist

Mobile, AL · On-site

... review. * Case consultation with referring Medical Department Representative. * Expert opinion in related medical board action. * Provide immediate evaluation and management of emergent problems as ...

Amazon

Staff Pharmacist, Amazon Pharmacy

Loxley, AL

$47 - $55.25/hr

... Drug Utilization Review) and ensure accurate documentation in pharmacy systems Monitor, receive, and manage pharmacy inventory effectively and compliantly Work collaboratively with pharmacy ...

Amazon

Staff Pharmacist, Amazon Pharmacy

Loxley, AL · On-site

$47 - $55.25/hr

... Drug Utilization Review) and ensure accurate documentation in pharmacy systems Monitor, receive, and manage pharmacy inventory effectively and compliantly Work collaboratively with pharmacy ...

AltaPointe Health

Care Manager

Mobile, AL · On-site

Conduct structured reviews of clinical records to assess service utilization, client engagement ... Participate in team huddles and interdisciplinary case discussions. * Compliance and Reporting

AltaPointe Health

Care Manager

AL · On-site

Conduct structured reviews of clinical records to assess service utilization, client engagement ... Participate in team huddles and interdisciplinary case discussions. * Compliance and Reporting

AltaPointe Health

Care Manager

Mobile, AL

Conduct structured reviews of clinical records to assess service utilization, client engagement ... Participate in team huddles and interdisciplinary case discussions. * Compliance and Reporting

Core Capabilities

Optometrist

Mobile, AL · On-site

... review. * Case consultation with referring Medical Department Representative. * Expert opinion in related medical board action. * Provide immediate evaluation and management of emergent problems as ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Mobile, AL

Utilization Review Case Manager information

See Mobile, AL salary details

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$59

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

As of Aug 19, 2026, the average hourly pay for utilization review case manager in Mobile, AL is $36.21, according to ZipRecruiter salary data. Most workers in this role earn between $29.33 and $38.17 per hour, depending on experience, location, and employer.

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 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 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 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 popular job titles related to Utilization Review Case Manager jobs in Mobile, AL?

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

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

The top searched job categories for Utilization Review Case Manager jobs in Mobile, AL are:

What cities near Mobile, AL are hiring for Utilization Review Case Manager jobs?

Cities near Mobile, AL with the most Utilization Review Case Manager job openings:

Utilization Review Case Manager jobs near you

PRN (RN) Home Health Case Manager- (Daphne/Bay Minette, AL) - ProHealth Home Health

ProHealth Home Health & Hospice

Daphne, AL • On-site

Part-time

Re-posted 3 days ago

Job description

Home Health Case Manager (RN)

JOB SUMMARY:

A Registered Nurse administers skilled nursing care to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of Clinical Services/Nursing Supervisor.

QUALIFICATIONS:

1. Graduate of an approved school of professional nursing and currently licensed in the state(s) in which practicing.

2. Two (2) years’ nursing experience, preferred.

3. Acceptance of philosophy and goals of this Agency.

4. Ability to exercise initiative and independent judgment.

RESPONSIBILITIES:

1. Provides services in accordance with the plan of care.

2. Makes the initial evaluation visit and regularly reevaluates the patient’s nursing needs.

3. Initiates the plan of care and necessary revisions.

4. Provides those services requiring substantial specialized nursing skills.

5. Initiates appropriate preventive and rehabilitative nursing procedures.

6. Prepares clinical and progress notes for each patient visit and summaries of care conferences on his/her patients in a timely manner as per Agency policy.

7. Coordinates services.

8. Informs personnel of changes in the condition and needs of the patient.

9. Counsels the patient and family/significant others in meeting nursing and related needs.

10. Participates in and presents inservice programs.

11. Understands and adheres to established Agency policies and procedures.

12. Processes orders and notifies physician of patient needs and changes in condition. Completes certification/recertification orders and discharge summaries.

13. Determines the amount and type of nursing needed by each individual patient.

14. Refers to Physical Therapist, Speech-Language Pathologist, Occupational Therapist and Medical Social Worker those patients requiring their specialized skills.

15. Supervises and teaches other nursing personnel.

16. Conducts patient care conferences on patients assigned to his/her care.

17. Participates in peer review and Quality Assessment and Performance Improvement as assigned.

18. Gives total patient care as needed.

19. Takes on-call duty nights, weekends, and holidays, as assigned.

20. Completes and submits OASIS assessments, reassessments, transfers, resumptions of care, discharges, and significant change in condition in accordance with Agency defined time frames.

22. Appropriately utilizes ICD-10 codes.

WORKING ENVIRONMENT:

Works indoors in Agency office and patient homes and travels to/from patient homes.

JOB RELATIONSHIPS:

1. Supervised by: Director of Clinical Services/Nursing Supervisor

2. Workers Supervised: Licensed Practical Nurse, Home Health Aide

LIFTING REQUIREMENTS:

Ability to perform the following tasks if necessary:

  • Ability to participate in physical activity.
  • Ability to work for an extended period of time while standing and being involved in physical activity.
  • Heavy lifting.
  • Ability to do extensive bending, lifting, and standing on a regular basis.

The ProHealth group of companies are equal opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status, or any other legally protected characteristic.

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