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Weekend Utilization Review 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 ...

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Weekend Utilization Review information

What does a typical weekend shift look like for a Utilization Review professional?

Weekend Utilization Review professionals typically work independently, reviewing patient cases for medical necessity, appropriateness of care, and compliance with payer guidelines during non-standard business hours. You will analyze patient charts, interact with clinical staff, and document findings, often collaborating remotely with other care coordinators or medical teams. While much of the role is desk-based, quick decision-making and effective communication are essential due to faster-paced weekend workflows. This schedule can offer greater autonomy and flexibility, but may also require prioritizing tasks and managing multiple cases efficiently to ensure continuous patient care.

What is a Weekend Utilization Review job?

A Weekend Utilization Review job involves assessing patient care and medical services during weekends to ensure they meet medical necessity and insurance guidelines. Professionals in this role review clinical documentation, coordinate with healthcare providers, and determine appropriate levels of care for patients. They typically work for hospitals, insurance companies, or other healthcare organizations. Strong analytical skills, medical knowledge, and familiarity with regulatory requirements are essential for success in this role.

What are the key skills and qualifications needed to thrive in the Weekend Utilization Review position, and why are they important?

Success as a Weekend Utilization Review professional requires a strong background in nursing or healthcare, critical thinking skills, and a thorough understanding of medical necessity criteria, such as InterQual or Milliman guidelines. Familiarity with electronic medical records (EMR) systems and utilization management software is highly beneficial, and RN or healthcare-related licensure is often required. Exceptional communication, attention to detail, and the ability to work independently on weekends are crucial soft skills. Mastering these areas allows efficient and accurate reviews of patient care, supporting optimal healthcare resource allocation outside of standard work hours.

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 Weekend Utilization Review jobs in Alabama? For Weekend Utilization Review jobs in Alabama, the most frequently searched job titles are:
What job categories do people searching Weekend Utilization Review jobs in Alabama look for? The top searched job categories for Weekend Utilization Review jobs in Alabama are:
What cities in Alabama are hiring for Weekend Utilization Review jobs? Cities in Alabama with the most Weekend Utilization Review job openings:
Weekend Utilization Review jobs near you
Utilization Review Nurse

Utilization Review Nurse

Southeast Health

Dothan, AL • On-site

Full-time

Posted 4 days ago

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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