Medical Claims Review Manager jobs in Birmingham, AL

VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, has an opportunity for a Case Manager, UR 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 can 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. 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, UR will evaluate members' needs and requirements to achieve and/or maintain an optimal wellness state. This position will guide members and their families toward interaction with resources appropriate for the care and well-being of members. The Case Manager, UR will collaborate with a multi-disciplinary team employing a variety of strategies, approaches, and techniques to manage members' physical, environmental, and psychosocial health issues. The Case Manager, UR will primarily perform fieldwork outside of the office setting. The incumbent will travel to locations within the VIVA HEALTH service area through a reliable means of transportation insured by Company policy. This position has work-from-home opportunities but requires occasional on-site work.

REQUIRED:

• Graduate of an accredited program of professional nursing, ADN/BSN
• Three years of experience in clinical nursing
• 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 and comprehensive clinical assessment skills for chronic disease management in adult populations
• 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
• Organization and Time Management skills
• Basic computer skills

PREFERRED:

• One year of experience in independent field-based clinical care
• One year of experience in case/complex care field management
• Ability to utilize Microsoft Word and Excel

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