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Registered Nurse for Utilization Management
2 months ago
Position Overview:
NaphCare is seeking skilled Registered Nurses specializing in Utilization Management to join our dynamic team. We are a family-owned medical technology organization dedicated to providing exceptional healthcare services to correctional facilities nationwide for over three decades.
As part of our growing team of over 4,000 professionals, NaphCare offers competitive compensation, comprehensive benefits, and a supportive corporate environment to ensure you excel in your role.
Our onsite teams take pride in serving a unique and diverse patient demographic, committed to delivering excellence in care to those in need.
Join a world-class team of healthcare professionals who are transforming correctional healthcare using our advanced resources, including our award-winning electronic operating system.Benefits for Full-Time Employees:
- Complimentary prescriptions through our health plan
- Health, dental, and vision insurance effective from day one
- Employment Assistance Program (EAP) services
- 100% vested 401K and Roth plans with company contributions starting immediately
- Tuition Assistance
- Referral bonuses
- On-site educational opportunities
- Free Continuing Education
- Term life insurance at no cost to employees
- Generous paid time off and holidays
NaphCare partners with NetCE to provide CEU/CME opportunities for our staff, ensuring all educational activities meet state-specific licensing requirements through a rigorous peer review process.
At NaphCare, you will play a vital role in our ongoing mission to be the premier provider of quality healthcare in the correctional sector.
We encourage professional growth and internal advancement. Once part of our team, we support our employees in seeking leadership and development opportunities.
Key Responsibilities:
Utilization Management Registered Nurse Responsibilities:
- Develop, implement, and oversee quality assurance and utilization review processes.
- Monitor and evaluate the quality of medical care provided to patients.
- Conduct utilization and concurrent reviews of patient cases.
- Perform thorough clinical chart assessments.
- Collect clinical information to assess and expedite patient care needs.
- Determine the necessity for intervention and consult with physicians as needed.
- Review provider requests regarding the medical necessity of services for patients.
- Audit patient medical records to assess medical necessity as required.
- Utilize nationally recognized criteria to evaluate the medical necessity of requested services.
- Refer provider requests to the Medical Director or designee when medical necessity does not meet established criteria.
Qualifications:
Utilization Management Registered Nurse Qualifications:
- A current and unrestricted RN license in Alabama.
- A minimum of three years of experience in an acute care setting and two years in utilization review and/or case management.
- Strong communication and interpersonal skills.
- Attention to detail and sound decision-making abilities are essential.
- BSN or ADN required.
- Some travel may be necessary.
Equal Opportunity Employer:
disability/veteran
