Utilization Management

1 week ago

Birmingham, Alabama, United States NaphCare Full time
Overview

Naphcare is seeking a Utilization Management Nurse Practitioner. This will be a PRN schedule, which is Monday-Friday dayshift and fully remote in Alabama. The role will consist of reviewing clinical charts to evaluate the medical necessity and appropriateness of off-site specialty visits, using our cutting-edge electronic health operating system. This position also performs case management for hospitalized patients.

NaphCare is a family owned, medical technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 30 years. Come join our team of over 4000 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. We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need. Be part of a world-class team of professionals who are revolutionizing correctional healthcare as you use our cutting-edge resources, including our award-winning electronic operating system

NaphCare Benefits for Full-Time Employees Include:
  • Prescriptions free of charge through our health plan
  • Health, dental & vision insurance that starts day one
  • Lowest Cost Benefits $44 for single, $105 for family
  • Employment Assistance Program (EAP) services
  • 100% vested 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 (UM) Liaison:
  • Perform various clerical and administrative functions, including contacting offsite providers with appointment or billing/claims inquiries
  • Use Microsoft Office, including Word and Excel, to prepare and maintain monthly reporting and statistical data and correspondence as required by company procedures
  • Transmit correspondence and medical records via email, mail or fax
  • Transmit and maintain all medical claims as required by company policies and procedures
  • Perform scheduling and coordination of offsite appointments when needed
  • Use all functions of TechCareTM relevant to the position with no supervision
  • Monitor and maintain relevant utilization management queue dashboards as well as perform non-licensed initial screening and approvals of specialty care offsite referrals
  • Proactively take action to solve problems and use objectivity and insightfulness when approaching problems, meet established goals, and take responsibility for results and outcomes
  • Fundamentally understand the organizational structure and how to appropriately access resources
  • Demonstrate professionalism by using objectivity, maintaining self control when under pressure, and promoting a positive work environment by setting an example
  • Build proactive work relationships with supervisors, security staff, healthcare staff, patients, vendors and clients
Qualifications

Qualifications for Utilization Management (UM) Liaison:
  • High School diploma or GED certificate required
  • Minimum two (2) years of college preferred
  • One (1) year clerical experience in healthcare setting preferred
  • Must have computer skills, including working knowledge of Microsoft Word and Excel with a minimum typing speed of 45 wpm
  • Must possess strong written communication and verbal skills and be able to manage stressful situations
  • Must have the physical and mental capacity to perform in a fast paced and challenging environment
We know you may have questions before applying. To speak to a recruiter directly, email your questions and/or resume to with the position and location you're interested in.

Equal Opportunity Employer: disability/veteran

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