Case Manager, Utilization Review

Viva-Health; Birmingham (AL); Hybrid; USD 65,000 - 85,000; Full time

Benefits offered by this job

Tuition reimbursement

401(k)

Paid parental leave

Paid day for community service

Job summary

VIVA HEALTH in Birmingham, AL is seeking a Case Manager, Utilization Review to support members and high-risk patients. The role involves coordinating utilization review activities, performing timely medical records checks, and determining medical necessity for admissions, stays, and services.

On-site or telework options apply, with potential travel within the service area. Required qualifications include a BSN/ADN, three years of clinical experience in acute or behavioral health, an active

Qualifications

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

Responsibilities

• Assist in development, planning, coordination, and administration of utilization review.
• Perform timely medical records checks to determine admission necessity.
• Assess continued stay and use of ancillary services.
• May perform on-site or telephonic reviews depending on location.
• Travel to locations within Viva Health service area as needed; work-from-home opportunities.

Skills

Clinical nursing experience

Customer service

Communication skills

Flexibility/adaptability

Basic computer skills

Education

ADN/BSN

Tools

Basic computer skills

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.