Case Manager, Utilization Review

Viva Health; Birmingham (AL); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Tuition reimbursement

401(k)

Paid parental leave

Community service day

Work-from-home opportunities

Job summary

Viva Health in Birmingham, AL seeks a Case Manager, Utilization Review to join our team. You will help develop and coordinate utilization review activities, perform medical records checks, and determine medical necessity for admissions. Some duties may be performed on-site, telephonically, or travel within the service area.

Work-from-home opportunities may be available based on duties. Requirements include an ADN/BSN and an active RN license in Alabama, with at least three years of clinical

Qualifications

• Graduate of a professional nursing program (ADN/BSN).
• Current RN license in good standing with Alabama Board of Nursing.
• Minimum of three years of clinical experience in acute, post-acute, or behavioral health settings.
• Knowledge of Medicare and Medicaid regulations.
• Willing to submit to vaccine testing and screening.
• Strong customer service and written/verbal communication skills.
• Basic computer skills for record-keeping and scheduling.

Responsibilities

• Assist in development, planning, coordination and administration of utilization review.
• Perform timely medical records checks to determine admission appropriateness and medical necessity.
• Work on-site or telephonically; may travel within Viva Health service area.
• Opportunity to work from home consistent with job duties and policy.

Skills

RN licensure in Alabama

ADN/BSN graduate

3 years clinical experience

Vaccine testing and screening

Medicare/Medicaid knowledge

Customer service & communication

Basic computer skills

Flexibility/adaptability

Education

BSN or ADN

Job description

Bham-Corporate Office
Birmingham, AL 35203, USA

Description

VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is seeking a Case Manager, Utilization Review position to join our team in Birmingham, AL!

VIVA HEALTH knows that nursing is not just a job; it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights and weekends. This way, you can do what you love at work and take care of the people you love at home! We also offer a great benefits package, including tuition reimbursement for employees and dependents, 401(K), paid parental leave, and paid day for community service, just to name a few!

The Case Manager, Utilization Review will assist in the development, planning, coordination, and administration of the activities involved in utilization review for VIVA HEALTH members and assigned UAB High-Risk Fund-approved patients. This position will perform timely medical records checks to determine the appropriateness and medical necessity of admission, continued stay, and use of ancillary services. These duties may be performed on-site or telephonically depending on the location. This position may travel to locations within the VIVA HEALTH service area through a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities.

REQUIRED:

• Graduate of a professional nursing program, ADN/BSN
• Three years of clinical experience in acute, post-acute, or behavioral health setting
• Current RN license in good standing with the State of Alabama Board of Nursing
• Valid driver's license in good standing
• May require significant face-to-face member contact with duties regularly performed away from the principal place of business
• Willing to submit to vaccine testing and screening
• Knowledge of Medicare and Medicaid regulations
• Ability to be flexible, adaptable, and able to work effectively in a variety of settings
• Demonstrate excellent customer service skills through written and verbal communication
• Basic computer skills

PREFERRED:

• Utilization review or case management experience
• HMO or MCO experience
• Disease management experience

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.