Medical Claims Review Manager jobs in Alabama

VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is seeking a Case Manager, Utilization Review position to join our team in Birmingham, AL!

VIVA HEALTH knows that nursing is not just a job; it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights and weekends. This way, you can do what you love at work and take care of the people you love at home! We also offer a great benefits package, including tuition reimbursement for employees and dependents, 401(K), paid parental leave, and paid day for community service, just to name a few!

VIVA HEALTH is the first and only Alabama-based plan to be named an overall 5-out-of-5 Star Medicare Advantage Plan for the third year in a row! Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team!

The Case Manager, Utilization Review will assist in the development, planning, coordination, and administration of the activities involved in utilization review for VIVA HEALTH members and assigned UAB High-Risk Fund-approved patients. This position will perform timely medical records checks to determine the appropriateness and medical necessity of admission, continued stay, and use of ancillary services. These duties may be performed on-site or telephonically depending on the location. This position may travel to locations within the VIVA HEALTH service area through a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities.

REQUIRED:

• Graduate of a professional nursing program, ADN/BSN
• Three years of clinical experience in 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
• May require significant face-to-face member contact with duties regularly performed away from the principal place of business
• Willing to submit to vaccine testing and screening
• Knowledge of Medicare and Medicaid regulations
• Ability to be flexible, adaptable, and able to work effectively in a variety of settings
• Demonstrate excellent customer service skills through written and verbal communication
• Basic computer skills

PREFERRED:

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

Click Here to learn more about how VIVA HEALTH is building a culture where diverse voices, backgrounds, and perspectives are welcomed and celebrated!