Top 2072 Quality management system Jobs in Birmingham, Al

Regional Director of Utilization Management
ADDICTION AND MENTAL HEALTH SERVICES, LLC —Birmingham, AL
- $115,000 - $130,000 a year
- Full-time
- Nursing
- 3 years
- Master's degree
- Loan repayment program
- Health insurance
13d
Clinical Quality Advisor
Alliant Health Solutions, Inc. —Birmingham, AL
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
4d
Pharmacy Customer Service Representative – Remote work from Home
Carlisle Medical, Inc. —Birmingham, AL
- Computer literacy
- Mid-level
- Communication skills
- Health insurance
- Dental insurance
RN-Quality Outcomes Coordinator - Quality Section
UAB Medicine —Birmingham, AL
- Full-time
- Nursing
- RN License
- 5 years
- Paid parental leave
- Health insurance
4d
LICENSED PLUMBER
PREMIUM PROPERTY MANAGEMENT —Birmingham, AL
- From $30 an hour
- Full-time
- Clean driving record
- Mid-level
- Residential
- Health insurance
- Dental insurance
Quick Apply
11d
Licensed Electrician
PREMIUM PROPERTY MANAGEMENT —Birmingham, AL
- From $28 an hour
- Full-time
- Clean driving record
- 5 years
- Residential
- Health insurance
- Dental insurance
Quick Apply
11d
Client Manager II – Commercial Insurance
TX IPS —Birmingham, AL
- $60,000 - $70,000 a year
- Call employer
- Hybrid work
- Mid-level
- Office
- 3 years
- Health savings account
- AD&D insurance
Quick Apply
13d
Cardiovascular, Acute Care RN - Baptist Health
Baptist Health —Birmingham, AL
- Acute care
- Nursing
- RN License
- Loan repayment program
- Tuition reimbursement
Experienced A&P Mechanic MST - Birmingham, AL
Textron Aviation —Birmingham, AL
- Urgently hiring
- Mechanic experience
- Customer service
- Mid-level
- Adoption assistance
- 401(k) matching
Construction Project Manager
Marathon Electrical Contractors, LLC —Birmingham, AL
- $70,000 - $95,000 an hour
- Overtime
- Construction site
- 5 years
- Office
- Dental insurance
- 401(k)
Quick Apply
Marketing Manager, Direct Marketing Products
STRONG AUTOMOTIVE MERCHANDISING LLC —Birmingham, AL
- Full-time
- Mid-level
- Organizational skills
- Communication skills
Quick Apply
12d
Surgical Technologist - Baptist Health
Baptist Health —Homewood, AL
- Full-time
- Surgery
- BLS Certification
- No experience needed
- Paid parental leave
- Health savings account
Director CV Stepdown
Grandview Medical Center —Birmingham, AL
- Full-time
- Nursing
- RN License
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
CERTIFIED HVAC TECHNICIAN
PREMIUM PROPERTY MANAGEMENT —Birmingham, AL
- From $28 an hour
- Full-time
- Clean driving record
- 5 years
- Residential
- Health insurance
- Dental insurance
Quick Apply
11d
Regional Personal Training Manager
Club4Fitness —Birmingham, AL
- $30,000 - $80,000 a year
- Extended hours
- CPR Certification
- BLS Certification
- Mid-level
Quick Apply
Sales Manager Trainee
Ridout's Gardendale Chapel —Gardendale, AL
- Full-time
- Clean driving record
- Public speaking
- Mid-level
Quick Apply
5d
Software Engineer Principal
PNC Financial Services Group —Birmingham, AL
- $65,000 - $187,200 a year
- Full-time
- 5 years
- Office
- Analysis skills
- Wellness program
- Health savings account
Revenue Cycle Manager
MainStreet Family Care —Birmingham, AL
- Monday to Friday
- Microsoft Excel
- Mid-level
- Organizational skills
- 401(k) matching
Quick Apply
Software Engineering Group Manager- Enterprise Enablement & Transformation
PNC Financial Services Group —Birmingham, AL
- $146,300 - $326,040 a year
- Full-time
- 5 years
- Office
- Master's degree
- Wellness program
- Health savings account
HS/PRS Bilingual Case Manager (Hybrid) (Proficiency in Spanish and English Required) ***
Presbyterian Home for Children —Hoover, AL
- From $61,100 a year
- Full-time
- Hybrid work
- Background check
- Spanish
- Addiction Medicine
- Health savings account
- Health insurance
Quick Apply

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Regional Director of Utilization Management

ADDICTION AND MENTAL HEALTH SERVICES, LLC -
Birmingham, AL

Apply Now

Job Details

Full-time
$115,000 - $130,000 a year
13 days ago

Benefits

Loan repayment program
Health insurance
Dental insurance
Paid time off
Employee assistance program
Vision insurance
Pet insurance

Qualifications

Appeals
Medicare
Team leadership
Regulatory compliance
Care documentation
Metrics Reporting
Case appeal in utilization management
Bachelor's degree
Pre-authorization review for utilization management
Utilization management
Clinical information systems
Clinical documentation
Healthcare team management
Management reporting
Medicaid
Business operations
Clinical documentation standards
Insurance claims appeal handling
Healthcare performance metrics analysis
Healthcare compliance
Healthcare data reporting

Full Job Description

About Company:

We’re officially a Great Place To Work®! We’ve always believed that supporting our team is just as important as supporting our patients. Now, we’re proud to share that we’ve earned Great Place To Work® Certification - based entirely on feedback from our own employees.

Read more here: https://ow.ly/YQ1C50WuRH1

This certification reflects the culture we’ve worked hard to build - one rooted in trust, inclusion, and purpose-driven leadership.

At Bradford Health Services, we are committed to providing exceptional care to our patients while fostering a supportive and rewarding workplace for our employees. We believe that taking care of our team allows them to take better care of others, which is why we offer a comprehensive benefits package designed to support their well-being.

Our benefits include:

Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits.
Expanded Coverage – Options for domestic partners and a wider network of in-network providers.
Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching.
Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more.
Student Loan Repayment – Available for nurses and therapists.
Retirement Benefits – 401(k) plan through Voya to help employees plan for the future.
Generous PTO – A robust paid time off policy to support work-life balance.
Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.

At Bradford Health Services, we don’t just invest in our patients—we invest in our people.

About the Role:

The Regional Director of Utilization Management provides strategic and operational leadership for Utilization Management services across an assigned geographic region, ensuring patients receive timely access to medically necessary care while optimizing reimbursement through effective authorization management, concurrent review, medical necessity documentation, and payer collaboration. Reporting to the Vice President of Revenue Cycle, the Regional Director is responsible for the operational performance, quality, productivity, and financial outcomes of the Utilization Review functions within the assigned region. This leader provides direct oversight of Utilization Review Managers and Utilization Review Coordinators while partnering closely with facility leadership, physicians, nursing, therapists, Centralized Admissions, Patient Access, and Revenue Cycle teams to improve authorization outcomes, reduce medical necessity denials, support medically appropriate lengths of stay, and ensure compliance with payer and regulatory requirements. The Regional Director serves as the operational expert for Utilization Management and is responsible for implementing standardized workflows, monitoring performance metrics, coaching leaders, and driving continuous process improvement throughout the assigned region.

Minimum Qualifications:

Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, Social Work, or related healthcare field required.
Minimum seven (7) years of progressive Utilization Management, Case Management, Revenue Cycle, or Behavioral Health leadership experience.
Minimum three (3) years leading multi-site teams.
Demonstrated Behavioral Health and/or substance use disorder (SUD) treatment experience required.
Experience managing concurrent review, medical necessity, payer authorizations, appeals, and utilization management operations.
Strong knowledge of commercial, Medicare, Medicaid, and VA authorization requirements.

Preferred Qualifications:

Master's degree in Nursing, Healthcare Administration, Business Administration, Public Health, or related field.
Certification in Case Management (CCM).
Knowledge of ASAM Criteria and behavioral health medical necessity guidelines.
Experience with enterprise EMR systems and reporting platforms.

Responsibilities:

Provide regional operational leadership for Utilization Management across assigned facilities.
Directly supervise Utilization Review Managers.
Establish accountability for quality, productivity, timeliness, and financial performance.
Ensure consistent implementation of enterprise Utilization Management standards.
Monitor staffing levels and workload distribution to optimize productivity and patient outcomes.
Oversee initial authorization and concurrent review activities.
Ensure timely submission of clinical documentation to payers.
Monitor authorization status to minimize interruptions in patient care.
Collaborate with clinical teams to maximize medically appropriate authorized days.
Escalate complex authorization issues as appropriate.
Promote accurate and complete clinical documentation supporting medical necessity.
Partner with physicians and clinical leadership to improve documentation quality.
Monitor trends related to authorization denials and documentation deficiencies.
Collaborate with clinical teams to improve documentation practices.
Oversee appeal strategy for medical necessity denials.
Support peer-to-peer review processes.
Identify payer trends and develop regional action plans.
Build collaborative relationships with payer representatives.
Participate in payer meetings and operational reviews.
Monitor regional performance metrics including:
- Authorization approval rate
- Initial authorization timeliness
- Continued stay (concurrent review) approval rate
- Medical necessity denial rate
- Appeal overturn rate
- Average approved Length of Stay
- Revenue at Risk
- Productivity
- Quality audit scores
Develop corrective action plans when performance targets are not achieved.

Skills:

The required skills enable the Regional Director of Utilization Management to provide strategic leadership across multiple facilities while ensuring operational excellence, regulatory compliance, and optimal reimbursement outcomes. Expertise in utilization management, concurrent review, medical necessity documentation, payer authorizations, and appeals supports effective collaboration with physicians, clinical teams, and payer representatives to improve authorization outcomes and reduce denials. Strong leadership, analytical, and performance management skills allow the Regional Director to oversee multi-site teams, implement standardized workflows, monitor key operational metrics, and drive continuous process improvement. Knowledge of commercial, Medicare, Medicaid, and VA payer requirements, along with experience using enterprise EMR systems and reporting platforms, supports data-driven decision-making, financial performance, and high-quality patient care across the region.

#INDHP

Apply Now

Refine Your Search

quality management system jobs in birmingham, al

Regional Director of Utilization Management

Clinical Quality Advisor

Pharmacy Customer Service Representative – Remote work from Home

RN-Quality Outcomes Coordinator - Quality Section

LICENSED PLUMBER

Licensed Electrician

Client Manager II – Commercial Insurance

Cardiovascular, Acute Care RN - Baptist Health

Experienced A&P Mechanic MST - Birmingham, AL

Construction Project Manager

Marketing Manager, Direct Marketing Products

Surgical Technologist - Baptist Health

Director CV Stepdown

CERTIFIED HVAC TECHNICIAN

Regional Personal Training Manager

Sales Manager Trainee

Software Engineer Principal

Revenue Cycle Manager

Software Engineering Group Manager- Enterprise Enablement & Transformation

HS/PRS Bilingual Case Manager (Hybrid) (Proficiency in Spanish and English Required) ***

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