Utilization Management Registered Nurse

Job Description

Job Description

Overview

NaphCare is hiring experienced Utilization Management Registered Nurse just like you at the Corporate Office located in Birmingham, AL.

NaphCare is a family owned, healthcare technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 35 years. Come join our team of over 5000 employees and growing! NaphCare pays well, offers outstanding benefits, and has an incredibly engaged corporate support team to make sure you have what you need to be truly excellent at what you do.

NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare.

NaphCare Full Time Benefits:

• Prescriptions free of charge through our health plan
• Health, dental & vision insurance that starts day one !
• We offer low cost benefits to our employees and their families
• Employment Assistance Program (EAP) services
• 401K and Roth with company contribution that starts day one!
• Tuition Assistance
• Referral bonuses
• On-site education
• Free Continuing Education!
• Term life insurance at no cost to the employee
• Generous paid time off & paid holidays

NaphCare has a partnership with NetCE that provides CEU/CME for our staff. NetCE uses a rigorous peer review process to ensure that all activities and content are up-to-date. This service streamlines continuing education for all NaphCare Employees to meet state specific requirements for maintaining licensing.

With NaphCare, you'll play a critical role in our continuing mission to be the leading provider of quality healthcare in the correctional industry. If you want a career that will make a difference, choose the company that is different.

We support your growth and internal promotion. Once hired, we encourage our employees to continue to seek opportunities for advancement and leadership.

Responsibilities

Responsibilities for Utilization Management Registered Nurse:

• Develop, implement, and administer the quality assurance and utilization review processes
• Monitor and report on the quality of all facets of the medical care provided to patients
• Perform utilization and concurrent review of patient cases
• Conduct detailed clinical chart assessments
• Gather clinical information to assess and expedite care needs
• Determine need, if any, for intervention, and discussing with physicians
• Reviews requests from providers regarding medical necessity of requested services for patients
• Reviews and audits patients' medical records as indicated to determine medical necessity
• Utilizes nationally recognized criteria to determine medical necessity of requested services
• Refers provider requests to Medical Director or designee when medical necessity of requested services does not meet recognized criteria

Qualifications

Qualifications for Utilization Management Registered Nurse:

• A current and unrestricted RN license in AL
• A minimum of 3 years’ experience in an acute care setting and 2 years’ experience in utilization review and/or case management
• Valid cpr card
• Excellent communication and interpersonal skills
• attention to detail and decision-making skills are essential
• BSN or ADN required.
• Some travel required.

We know you may have questions before applying. To speak to a recruiter directly, email your questions and/or resume to [email protected] with the position and location you’re interested in.

Equal Opportunity Employer: disability/veteran