Top 19 utilization management Jobs in boykin al

RN Manager of Care Management
Grandview Medical Center —Alabama
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
14d
Physician Assistant/Nurse Practitioner (D), CVOR - Regional
Corewell Health —United States
- Weekends as needed
- Acute care
- Nursing
- Surgery
- Free parking
- Paid holidays
Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
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RN Inpatient Hospital Auditor | Remote | Contract
Walker Healthforce, LLC —United States
- Contract
- Remote
- Anatomy knowledge
- RN License
- Mid-level
- Health insurance
- Dental insurance
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Senior Drug Information Pharmacist
GoldenScript —United States
- $130,000 - $170,000 a year
- Full-time
- 3 years
- Analysis skills
- Senior level
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Advanced Practice Provider Lead (NP or PA) – NJ Palliative Care
NJ Palliative Care Solutions —United States
- $160,000 - $190,000 a year
- Full-time
- Bilingual
- 5 years
- Outpatient
Quick Apply
10d
Remote Pharmacy Technician
Rapid Talent Group —United States
- $21 an hour
- 8 hour shift
- Remote
- Research
- Mid-level
- High school diploma or GED
- Paid training
- Work from home
Quick Apply
7d

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Nurse Practitioner
4 POINTS PRIMARY CARE —Andalusia, AL
Active Alabama Nurse Practitioner license. DEA license preferred or the ability to obtain. Develop and implement individualized treatment plans in accordance…
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RN Manager of Care Management
Grandview Medical Center —Alabama
Proficiency with Google and Microsoft platforms, healthcare software systems, and data analysis tools. Bachelor's Degree in relevant field required or.
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Director, Inpatient Coding and Compliance
The Ohio State University —Columbus, OH
The information collected and used by medical information management staff is interconnected with the clinical and business systems of the health system and is…
RN, LSW, LISW, Care Manager
Careforth —Columbus, OH
Ability and flexibility to travel (usually by car) within assigned geographic area; valid driver’s license and car insurance required.
$68,700 - $84,200 a year
7d

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utilization management jobs near boykin al

RN Manager of Care Management

Grandview Medical Center -
Alabama

Quick Apply

Job Details

Full-time
14 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Opportunities for advancement
Life insurance

Qualifications

Collaborate with healthcare professionals
Clinical staff performance evaluation
Managed case managers
Clinical program budget management
Operational analysis
Care plan evaluation
Nursing
Staff supervision
Strategic goal setting
Strategic management
Team member evaluation
Patient resource coordination
Process audits
Utilization review
Accreditation standards (regulatory compliance area)
RN License
Quality of care (regulatory compliance area)
LMSW
Patient assessment
Staff scheduling
Operations coordination planning
Licensed Clinical Social Worker
Hospital quality control
Team scheduling
Performance feedback (performance evaluation method)
Improving operational efficiency
Data summary reports
Master's degree
Quality reports
Team development

Full Job Description

Why Join Us?

Competitive Compensation
Comprehensive Medical, Dental, Vision & Life Insurance
Generous Paid Time Off & Extended Illness Bank
Matching 401(k) Retirement Plan
Opportunities for Career Grown & Advancement
Recognition & Reward Programs
Exclusive Discounts & Perks*

About Us

Grandview Medical Center is a 434-bed tertiary care hospital that provides healthcare services to patients in Birmingham and surrounding communities. Our mission is to provide quality health care with kindness and clinical excellence - personalized through compassion and faith.

Job Summary

The Manager, Care Management is responsible for the planning, coordination, and oversight of care management services, including utilization review, discharge planning, and transitions of care. The role ensures care is appropriate, timely, cost-effective, and aligned with patient needs and organizational goals. The Manager leads the daily operations of the Care Management department, supervises staff, and collaborates with physicians, nurses, payors, and other healthcare team members to facilitate care coordination, improve outcomes, and support effective resource utilization.

Essential Functions

Manages the daily operations of the Care Management department, ensuring services are delivered efficiently, effectively, and in compliance with organizational standards.
Oversees utilization review and discharge planning processes to ensure appropriateness of admission, continued stay, diagnostic services, and discharge readiness.
Directs and prioritizes workload based on patient length of stay, diagnosis-related groups (DRGs), charges, reimbursement, and other risk factors.
Evaluates patients through chart review, interviews with providers and staff, and patient assessments to support care planning and transitions.
Collaborates with physicians, nurses, ancillary services, and payors to streamline care, resolve barriers, and ensure timely discharge planning.
Monitors observation stays and ensures compliance with regulatory requirements, timely admission, or discharge decisions.
Prepares and delivers reports on utilization, care management performance, and variance from expected outcomes to facility and organizational leadership.
Performs other duties as assigned.
Maintains regular and reliable attendance.
Complies with all policies and standards.

Leadership Responsibilities

Supervision and Staff Management
- Provides leadership, mentorship and professional development opportunities for departmental staff.
- Schedules employees to ensure effective use of resources. Consults with Director on staffing issues.
- Conducts performance evaluations, sets goals and provides feedback to staff on their performance and development.
Strategic Planning and Financial Oversight
- Develops and manages departmental budget ensuring cost effective operations while maintaining high quality service.
- Monitors expenditures, ensuring cost-effective delivery of services.
- Evaluates and implements new technologies to enhance operational efficiency.
- Develops and implements departmental policies and procedures and protocols to optimize quality and overall efficiencies.
Quality Assurance and Regulatory Compliance
- Ensures compliance with all relevant regulatory bodies. May oversee the accreditation process with relevant agencies ensuring that services meet or exceed industry standards.
- Participates in audits, inspections and accreditation processes as applicable.
- Follows established quality control practices to ensure accuracy, consistency and safety.
Collaboration and Communication
- Works closely with leadership teams to coordinate and improve service delivery.
- Stays up-to-date with industry advancements, new technologies, and regulatory changes.
Staff Responsibilities
- May work in a staff role, when required. Ensures that duties and responsibilities are fulfilled while meeting all competencies established for that job.

Qualifications

Bachelor's Degree in relevant field required or
Four (4) plus years of direct experience in lieu of a Bachelor's degree required
Master's Degree preferred
2-4 years of experience in closely related field with Bachelor's degree required
2-4 years of previous leadership experience preferred

Knowledge, Skills and Abilities

Strong leadership, organizational, and communication skills.
Ability to collaborate with interdisciplinary teams and manage cross-functional relationships.
Foster a positive work environment that promotes teamwork, professionalism, and continuous improvement.
Communicate effectively with leadership, team members, and stakeholders.
Ability to work effectively with others, delegate responsibilities, and independently manage tasks while meeting established deadlines.
Problem-solving and critical thinking skills.
In depth knowledge of industry best practices and regulatory compliance (if applicable).
Strong organizational and time management skills.
Proficiency with Google and Microsoft platforms, healthcare software systems, and data analysis tools.

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure required or
LCSW- License Clinical Social Worker required or
LMSW - Licensed Medical Social Worker - State Licensure required

INDLEAD

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Refine Your Search

utilization management jobs in boykin al

RN Manager of Care Management

Physician Assistant/Nurse Practitioner (D), CVOR - Regional

Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)

RN Inpatient Hospital Auditor | Remote | Contract

Senior Drug Information Pharmacist

Advanced Practice Provider Lead (NP or PA) – NJ Palliative Care

Remote Pharmacy Technician

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