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Utilization Review Rn Jobs in Birmingham, AL (NOW HIRING)

UHS

Utilization Review Coordinator

Birmingham, AL · On-site

Responsibilities Utilization Review Coordinator- Full-time The Utilization Review Coordinator ... Nursing BSN or RN. * Strong organizational skills and excellent interpersonal and strong ...

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of May 28, 2026, the average hourly pay for utilization review rn in Birmingham, AL is $39.63, according to ZipRecruiter salary data. Most workers in this role earn between $31.30 and $45.53 per hour, depending on experience, location, and employer.

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

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

What are the most commonly searched types of Utilization Review Rn jobs in Birmingham, AL? The most popular types of Utilization Review Rn jobs in Birmingham, AL are:
What are popular job titles related to Utilization Review Rn jobs in Birmingham, AL? For Utilization Review Rn jobs in Birmingham, AL, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Birmingham, AL look for? The top searched job categories for Utilization Review Rn jobs in Birmingham, AL are:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Birmingham, AL as of May 2026, with employment types broken down into 100% Full Time. Highlights an 74% In-person, and 26% Remote job distribution, with an average salary of $82,423 per year, or $39.6 per hour.
Utilization Management Registered Nurse

Utilization Management Registered Nurse

Naphcare, Inc.

Birmingham, AL

Full-time

Posted 27 days ago

NaphCare rating

5.9

Company rating: 5.9 out of 10

Based on 47 frontline employees who took The Breakroom Quiz

740th of 864 rated healthcare providers

Job description

Overview

NaphCare is hiring experienced Utilization Management Registered Nurse just like you at the Corporate Office located in Birmingham, AL.

NaphCare is a family owned, healthcare technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 35 years. Come join our team of over 5000 employees and growing! NaphCare pays well, offers outstanding benefits, and has an incredibly engaged corporate support team to make sure you have what you need to be truly excellent at what you do.

NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare.

NaphCare Full Time Benefits:

  • Prescriptions free of charge through our health plan
  • Health, dental & vision insurance that starts day one!
  • We offer low cost benefits to our employees and their families
  • Employment Assistance Program (EAP) services
  • 401K and Roth with company contribution that starts day one!
  • Tuition Assistance
  • Referral bonuses
  • On-site education
  • Free Continuing Education!
  • Term life insurance at no cost to the employee
  • Generous paid time off & paid holidays

NaphCare has a partnership with NetCE that provides CEU/CME for our staff. NetCE uses a rigorous peer review process to ensure that all activities and content are up-to-date. This service streamlines continuing education for all NaphCare Employees to meet state specific requirements for maintaining licensing.

With NaphCare, you'll play a critical role in our continuing mission to be the leading provider of quality healthcare in the correctional industry. If you want a career that will make a difference, choose the company that is different.

We support your growth and internal promotion. Once hired, we encourage our employees to continue to seek opportunities for advancement and leadership.


Responsibilities

Responsibilities for Utilization Management Registered Nurse:

  • Develop, implement, and administer the quality assurance and utilization review processes
  • Monitor and report on the quality of all facets of the medical care provided to patients
  • Perform utilization and concurrent review of patient cases
  • Conduct detailed clinical chart assessments
  • Gather clinical information to assess and expedite care needs
  • Determine need, if any, for intervention, and discussing with physicians
  • Reviews requests from providers regarding medical necessity of requested services for patients
  • Reviews and audits patients' medical records as indicated to determine medical necessity
  • Utilizes nationally recognized criteria to determine medical necessity of requested services
  • Refers provider requests to Medical Director or designee when medical necessity of requested services does not meet recognized criteria

Qualifications

Qualifications for Utilization Management Registered Nurse:

  • A current and unrestricted RN license in AL
  • A minimum of 3 years’ experience in an acute care setting and 2 years’ experience in utilization review and/or case management
  • Valid cpr card
  • Excellent communication and interpersonal skills
  • attention to detail and decision-making skills are essential
  • BSN or ADN required.
  • Some travel required.

We know you may have questions before applying. To speak to a recruiter directly, email your questions and/or resume to CorporateHR@naphcare.com with the position and location you’re interested in.

Equal Opportunity Employer: disability/veteran

What NaphCare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About NaphCare

Sourced by ZipRecruiter

NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need. Be part of a world-class team of professionals who are revolutionizing correctional healthcare. NaphCare offers competitive compensation! Our full-time teammates have a top-notch benefits package, which includes medical, dental, vision, FREE prescriptions, flexible spending account, company-paid life and AD&D insurance with voluntary life and AD&D options, ST & LT disability, 401(k) company contribution, 20 days Paid Time Off, paid holidays, tuition assistance, employee referral bonuses, etc.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Birmingham, AL, US

Year founded

1989

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