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Utilization Review Manager Jobs in Alabama (NOW HIRING)

Southeast Health

Utilization Review Nurse

Dothan, AL · On-site

The Utilization Review case manager collaborates with all components of the healthcare system, managing appropriate use of acute care to aid in the achievement of quality outcomes, fiscal ...

Birmingham

Quality Review Coordinator

Birmingham, AL · On-site

ENVIRONMENT The Health Managed Department is responsible for developing, implementing and administering private business and government utilization review, medical review, cost containment ...

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Utilization Review Manager information

See Alabama salary details

$35.3K

$82.5K

$151.8K

How much do utilization review manager jobs pay per year?

As of Jul 20, 2026, the average yearly pay for utilization review manager in Alabama is $82,492.00, according to ZipRecruiter salary data. Most workers in this role earn between $53,900.00 and $99,200.00 per year, depending on experience, location, and employer.

What are some common challenges faced by Utilization Review Managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

What are the key skills and qualifications needed to thrive as a Utilization Review Manager, and why are they important?

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What is the difference between Utilization Review Manager vs Utilization Review Coordinator?

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

What does a Utilization Review Manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.
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 Utilization Review Manager jobs in Alabama? For Utilization Review Manager jobs in Alabama, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Alabama look for? The top searched job categories for Utilization Review Manager jobs in Alabama are:
What cities in Alabama are hiring for Utilization Review Manager jobs? Cities in Alabama with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Alabama as of July 2026, with employment types broken down into 76% Full Time, 18% Part Time, 1% Temporary, and 5% Contract. Highlights an 86% Physical, 1% Hybrid, and 13% Remote job distribution, with an average salary of $82,492 per year, or $39.7 per hour.
Utilization Review Nurse

Utilization Review Nurse

Southeast Health

Dothan, AL • On-site

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Southeast. Always the right career direction.
Job Description Summary
The Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute care setting. The Utilization Review case manager collaborates with all components of the healthcare system, managing appropriate use of acute care to aid in the achievement of quality outcomes, fiscal responsibility, and patient satisfaction.
Job Description
Essential Functions
  • Performs admissions and continued stay reviews of all inpatients and outpatient/observation patients in a bed; at times, this may be retrospective.
  • Performs precertification on procedures ordered while patients are hospitalized.
  • Issues required Medicare/Medicaid notifications of medical necessity changes to patients while hospitalized.
  • Issues notifications of non-coverage letters to patients if received during hospital stay.
  • Documents clear billing notes into the Electronic Medical Record (EMR) payer communications navigator to avoid billing denials.
  • Performs medical necessity denial appeals.
  • Maintains a close, collaborative relationship with the medical staff to promote continuity of care and avoid delays in service.
  • Performs other duties as requested by primary manager that do not compromise moral code of conduct or protocols set in place for patient or employee safety
Supervised Positions
  • None

Qualifications
Minimum Education Required
  • Associates degree in Nursing
  • Current Registered Nurse license in the State of Alabama
Minimum Education Preferred
  • Bachelor's degree or higher in Nursing
Minimum Experience Required
  • Two (2) years acute care experience
  • Must pass Blue Cross Blue Shield Iterator Reliability Test with 90% within six (6) months of hire
Minimum Experience Preferred
  • Three (3) years acute care experience
  • One (1) year utilization review experience

Required Knowledge/ Skills/ Abilities
  • Maintain current licensure in the State of Alabama
  • Demonstrates appropriate utilization of the skills of the Registered Nurse as approved by the Alabama Board of Nursing
  • Ability to quickly adapt to changing circumstances in fast-paced environment
  • Actively accepts, understands, and practices appropriate standards of nursing practice.
  • Must demonstrate basic knowledge of discharge planning needs
  • Demonstrates advanced computer skills (ability to generate reports, graph trends).
  • Clinical knowledge and experience in the care of patients with multiple and complex diagnoses, disease process, and care needs.
  • Ability to prioritize work and meet deadlines.
  • Ability to problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge.
  • Ability to develop leadership skills and to serve as a role model for clinical staff.
  • Ability to lead and actively participate in multidisciplinary teams.
  • Ability to work independently within a team structure.
  • Demonstrates responsibility for educational requirements as evidenced by reading all assigned related references, and attending all required educational meetings, or webinars, and completing annual Symplr requirements.
  • Demonstrates commitment to organizations five (5) priorities and Six Ground Rules
  • Person in this position is required to understand, agree upon and follow our Six Ground Rules:
    • No excuses.
    • We are a team.
    • Bring up your ideas.
    • Poor performance will be addressed.
    • 'That's not my job' is not acceptable
    • Manage Up.

Shift
DayShift Details
8:00 am - 4:30 pm
FTE
1
Type
Regular
Join one of Forbes 500 best mid-sized employers in America.
Equal Employment Employer
Southeast Health is committed to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Southeast Health will provide reasonable accommodations for qualified individuals with disabilities.

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