Case Manager, Utilization Review

Viva Health • Birmingham, AL

2d

About The Position

VIVA HEALTH is seeking a Case Manager, Utilization Review to join its team in Birmingham, Alabama. The position assists in developing, planning, coordinating, and administering utilization review activities for VIVA HEALTH members and assigned UAB High-Risk Fund-approved patients. It conducts timely medical-record reviews to determine the appropriateness and medical necessity of admissions, continued stays, and ancillary services. Duties may be performed on-site or by telephone, depending on location, and the role offers work-from-home opportunities. Travel to locations within the VIVA HEALTH service area may be required using reliable transportation insured in accordance with company policy. The position may involve significant face-to-face member contact, with duties regularly performed away from the principal place of business. The role offers regular hours with no mandatory nights or weekends.

Requirements

• Graduate of a professional nursing program (ADN or BSN).
• Three years of clinical experience in an 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.
• Willingness to submit to vaccine testing and screening.
• Knowledge of Medicare and Medicaid regulations.
• Ability to be flexible, adaptable, and effective in a variety of settings.
• Excellent written and verbal communication and customer service skills.
• Basic computer skills.
• Reliable transportation insured in accordance with company policy.

Nice To Haves

• Utilization review or case management experience.
• HMO or MCO experience.
• Disease management experience.
• Certified Case Manager (CCM).

Responsibilities

• Assist in the development, planning, coordination, and administration of utilization review activities for VIVA HEALTH members and assigned UAB High-Risk Fund-approved patients.
• Conduct timely medical-record reviews to determine the appropriateness and medical necessity of admissions, continued stays, and use of ancillary services.
• Perform duties on-site or by telephone, depending on location.
• Travel to locations within the VIVA HEALTH service area as needed.
• Provide face-to-face member contact when required.

Benefits

• Tuition reimbursement for employees and dependents.
• 401(K).
• Paid parental leave.
• Paid day for community service.
• Regular hours with no mandatory nights or weekends.
• Work-from-home opportunities.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree