Top 32 Utilization review Jobs in Birmingham, Al

Care Coordinator
Behavioral Health Systems, Inc. —Birmingham, AL
- $66,000 - $70,000 a year
- Full-time
- Background check
- 5 years
- HIPAA
- Disability insurance
- Health insurance
Quick Apply
Senior Manager, Regulatory Compliance
Behavioral Health Systems, Inc. —Birmingham, AL
- $120,000 - $150,000 a year
- Full-time
- Hybrid work
- 5 years
- Case management
- Travel
- Health insurance
- Dental insurance
Quick Apply
Quality Utilization Reviewer I
Children's of Alabama —Birmingham, AL
- 8 hour shift
- Nursing
- RN License
- Bachelor of Science
7d
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
8d
Administrative Assistant
Naphcare, Inc. —Birmingham, AL
- Full-time
- Pass drug screening
- Residential
- High school diploma or GED
- Paid holidays
- Health insurance
Rehab Case Manager - Rehabilitation Admissions - Flex/PRN (886)
UAB Medicine —Birmingham, AL
- $45 an hour
- PRN
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Tuition reimbursement
RN - Registered Nurse - Utilization Review - PRN Days
UAB St. Vincent's —Birmingham, AL
- PRN
- Nursing
- RN License
- Hospital
- Paid parental leave
- Tuition reimbursement
8d
Clinical Documentation Integrity Registered Nurse RN- Hybrid
Conifer Revenue Cycle Solutions —Birmingham, AL
- Full-time
- Microsoft Word
- Nursing
- Medicine
Care Coordinator
Workplace Options —Birmingham, AL
- Full-time
- 5 years
- HIPAA
- Mid-level
Quick Apply
RN-CASE MGR | CASE MANAGEMENT
MEDICAL WEST HOSPITAL AUTHORITY —McCalla, AL
- Full-time
- Nursing
- RN License
- Bachelor of Science
Social Worker, Care Manager, Behavioral Health
VIVA HEALTH —Birmingham, AL
- No weekends
- Master of Social Work
- Computer literacy
- Mid-level
- Paid parental leave
- Tuition reimbursement
Quick Apply
RN - Case Manager - Inpatient Care Management - Multiple Shifts
UAB Medicine —Birmingham, AL
- $67,070 - $108,990 a year
- Full-time
- Nursing
- RN License
- PALS Certification
- Paid parental leave
- Tuition reimbursement
RN- Clinical Team Leader - Home Health
Enhabit Home Health & Hospice —Gardendale, AL
- Full-time
- Experience working with individuals with developmental disabilities
- Nursing
- Vital signs
- Health insurance
- Dental insurance
8d
Senior Medical Director
Oak Street Health —Birmingham, AL
- $184,112 - $396,550 a year
- Full-time
- Medicine
- Outpatient experience
- 3 years
- Health insurance
- Dental insurance
Care Coordination Nurse
Children's of Alabama —Birmingham, AL
- Part-time
- Microsoft Word
- Nursing
- RN License
Clinical Manager
Warrior at Bradford Health —Birmingham, AL
- Full-time
- Addiction Medicine
- Licensed Clinical Social Worker
- LPC
- Loan repayment program
- Health insurance
12d
Regional Medical Director (Pediatrics)-GA/TN/AL
Zarminali Pediatrics —Birmingham, AL
- Medicine
- Clinic
- Children
Quick Apply
6d
RN Unit Manager
Cavalier Healthcare of Trussville LLC —Trussville, AL
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply
4d
Mental Health Psychiatric Nurse Practioner
First Class Healthcare LLC —Birmingham, AL
- Background check
- Nursing
- Psychiatry
Quick Apply
14d
Unit Manager - RN
South Haven Health And Rehabilitation LLC —Hoover, AL
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
8d

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Care Coordinator

Behavioral Health Systems, Inc. -
Birmingham, AL

Quick Apply

Job Details

Full-time
$66,000 - $70,000 a year

Benefits

Disability insurance
Health insurance
Dental insurance
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Opportunities for advancement
Life insurance
Prescription drug insurance
Paid sick time

Qualifications

Utilization review
Intake
Employment & labor law
Master's degree
Mental health facility experience
Psychology
Data collection

Full Job Description

Behavioral Health Systems, Inc. seeks a Care Coordinator to join our Clinical Services Team. Under the direction of the Vice President, Clinical Services, and with the guidance of the BHS Medical Director, and the EVP & Chief Clinical Officer, this position is responsible for overseeing and coordinating all patient care activities within the Clinical Services Division. Specific responsibilities include referral and case management activities across all client locations, clinical administration of client benefits and participation in utilization review and quality assurance activities.

Specific Duties:

Under the direction of the Director, Clinical Services:

1. Perform care management coordination activities for managed care, employee assistance, and workers’ compensation beneficiaries system-wide to include: scheduling and direct case management reviews, communication with hospitals, attending physicians, outpatient providers, etc., effectiveness review and monitoring functions, quality assurance.

2. Receive calls from patients, providers, and facilities; arrange for appropriate intake assessments; schedule and refer to appropriate case manager in local area. Perform appropriate monitoring activities on a regular basis. Provide coverage to the Clinical Services Division as deemed necessary.

3. Explain benefits to employees, patients and treatment providers. Verify benefit eligibility and maintain appropriate communication with Client company contacts. Maintain positive interactions with patients, providers and Clients.

4. Participate in utilization review and quality assurance activities, as directed. Coordinate U.R. activities with the BHS physician review panel as appropriate, to include ensuring on-going and timely peer/clinical review of active inpatient and outpatient cases.

5. Adhere to established BHS clinical policies, procedures and utilization review guidelines, HIPAA standards, ERISA regulations, URAC standards.

6. Review incoming claims for completeness of data and appropriate approval, in cooperation with data processing and the Accounting Division. Cooperate in data analysis process by other divisions.

7. Serve as clinical liaison for EAP accounts to include communication with clients, assisting with quarterly and annual reports.

8. Provide after hours coverage for emergencies on a shared basis, collecting data based on structured intake questionnaire and arranging for peer review.

9. Assist in the clinical coordination of patient activities and cases as requested.

10. In cooperation with the Provider Relations Division facilitate emergency case-specific facility hook-ups or transfers as deemed appropriate. Maintain contact with members as needed regarding the status of provider requests.

11. Interact with the BHS physician review panel and coordinate case reviews for medical necessity purposes. Maintain strong liaison with physician reviewers and the Medical Director.

12. Maintain patient and departmental files, policies, procedures, budgets. Assist in achievement of annual goals, objectives and divisional action plans.

13. Perform other related duties as directed or deemed appropriate. Attend meetings as directed. Maintain professional competency through continuing education, conferences, and internal training.

Qualifications:

- Masters degree in Psychology or related field required

- Active, professional licensure or certification to practice in the behavioral health field in a state or territory of the United States required

- QA/UR experience in psychiatric setting

- Minimum five years experience in mental health field

- Prefer experience in services to business and industry

- Exposure to computerized applications

- Strong organizational and communication skills

Job Type: Full-time

Pay: $66,000.00 - $70,000.00 per year

Benefits:

401(k) matching
Dental insurance
Disability insurance
Employee assistance program
Health insurance
Life insurance
Opportunities for advancement
Paid sick time
Paid time off
Prescription drug insurance
Vision insurance

Work Location: In person

Quick Apply

Refine Your Search

utilization review jobs in birmingham, al

Care Coordinator

Senior Manager, Regulatory Compliance

Quality Utilization Reviewer I

Regional Director of Utilization Management

Administrative Assistant

Rehab Case Manager - Rehabilitation Admissions - Flex/PRN (886)

RN - Registered Nurse - Utilization Review - PRN Days

Clinical Documentation Integrity Registered Nurse RN- Hybrid

Care Coordinator

RN-CASE MGR | CASE MANAGEMENT

Social Worker, Care Manager, Behavioral Health

RN - Case Manager - Inpatient Care Management - Multiple Shifts

RN- Clinical Team Leader - Home Health

Senior Medical Director

Care Coordination Nurse

Clinical Manager

Regional Medical Director (Pediatrics)-GA/TN/AL

RN Unit Manager

Mental Health Psychiatric Nurse Practioner

Unit Manager - RN

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