Director of UM, Prisons
Naphcare, Inc.•Birmingham, MI
•Onsite
About The Position
NaphCare is hiring a Director of Utilization, Prisons, at its corporate headquarters in Birmingham, Alabama. NaphCare is a family-owned healthcare technology company that provides healthcare services to correctional facilities across the nation. The Director will develop and administer quality assurance and utilization review processes, monitor the quality of medical care, and assess the medical necessity of requested services using nationally recognized criteria. The position includes reviewing patient records and working with physicians when intervention may be needed.
Requirements
- Current and unrestricted RN license.
- At least 6 years of experience in an acute care setting.
- At least 4 years of experience in utilization review and/or case management.
- Excellent communication and interpersonal skills.
- Attention to detail and decision-making skills.
- Valid CPR card.
Responsibilities
- Understand the principles and concepts of medical quality assurance and utilization review.
- Develop, implement, and administer quality assurance and utilization review processes.
- Monitor and report on the quality of all facets of medical care provided to patients.
- Determine whether intervention is needed and discuss it with physicians.
- Review providers’ requests regarding the medical necessity of services for patients.
- Review and audit patient medical records as indicated to determine medical necessity.
- Use nationally recognized criteria to determine the medical necessity of requested services.
Benefits
- Prescriptions at no charge through the health plan.
- Health, dental, and vision insurance starting on day one.
- Low-cost benefits for employees and their families.
- Employment Assistance Program (EAP) services.
- 401(k) and Roth plans with company contribution starting on day one.
- Tuition assistance.
- Referral bonuses.
- On-site education.
- Free continuing education, including CEU/CME opportunities through NetCE.
- Term life insurance at no cost to the employee.
- Generous paid time off and paid holidays.
- Opportunities for growth, advancement, and internal promotion.
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
No Education Listed
