Case Manager - Utilization Review

Job description

Fulltime: Monday - Friday Job Summary: The Case Manager – Utilization Review is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. This role ensures compliance with regulatory requirements, payer guidelines, and hospital policies while promoting optimal patient outcomes and effective resource utilization. The Case Manager collaborates with physicians, nursing staff, and payers to support timely care progression, appropriate level of care determinations, and safe discharge planning. Pre-Employment Requirements: - We are a drug free facility. Passing a pre-employment drug screening is required. LICENSURE/CERTIFICATIONS: EXPERIENCE/QUALIFICATIONS: - Graduate of an accredited school of nursing required (LPN or RN). - Additional education in case management, healthcare administration, or a related field preferred. - Registered Nurse (RN) license in the State of Alabama required, or a current multistate license in a Nurse Licensure Compact (NLC) state permitting practice in Alabama. - Certification in Case Management (e.g., CCM) or Utilization Review preferred. - Minimum of one (1) year of clinical experience req...