Remote RN 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

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