Regional Utilization Management Registered Nurse
Naphcare, Inc.•Montgomery, AL
•Onsite
About The Position
NaphCare Alabama Prisons LLC is hiring a Regional Utilization Management Registered Nurse for its Regional Office in Montgomery, AL, managing healthcare for individuals incarcerated in the Alabama Department of Corrections. This unique position involves working alongside correctional officers and other medical professionals to provide care to a diverse patient population.
Requirements
- A current and unrestricted RN license in AL
- A minimum of 3 years’ experience in an acute care setting
- 2 years’ experience in utilization review and/or case management
- Valid BLS CPR card (AHA preferred)
- Excellent communication and interpersonal skills
- Attention to detail and decision-making skills are essential
- BSN or ADN required.
Nice To Haves
- Some travel required
Responsibilities
- 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
Benefits
- Health, dental & vision insurance that starts day one!
- Prescriptions free of charge through our health plan, beginning day one
- Lowest Cost Benefits!
- Employee Assistance Program (EAP) services
- 401K and Roth with company contribution that starts day one!
- Tuition Assistance
- Referral bonuses
- Term life insurance at no cost to the employee
- Generous paid time off & paid holidays
- Free continuing education and CMEs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
