Senior Director of Utilization Management

NaphCare • Mountain Brook, AL

111d

About The Position

NaphCare has an excellent opportunity for a Senior Director of Utilization Management to join our team at our Corporate Headquarters office located in Birmingham, AL. This is an on-site position. NaphCare is one of the largest providers of healthcare services to correctional facilities throughout the United States. NaphCare is a family owned, healthcare technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 36 years. NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. Come join our growing team of 7,000 + employees! The Senior Director of Utilization Management (Sr. UM) will provide leadership and oversight of utilization management processes across our correctional healthcare system. This individual must be a licensed Nurse Practitioner (NP), with correctional healthcare experience strongly preferred, who will supervise a team of UM nurses and NPs. The Sr. UM will ensure appropriate use of medical services, streamline clinical workflows, and uphold compliance with standards and contractual requirements.

Requirements

• Licensed Nurse Practitioner (NP) with active, unrestricted license.
• Correctional healthcare experience strongly preferred.
• Demonstrated expertise in Utilization Management and care coordination.
• Strong leadership and team management skills, with the ability to supervise clinical staff across multiple locations.
• Excellent communication, analytical, and decision-making skills.
• Familiarity with NCCHC/ACA standards and correctional healthcare regulations.
• Willingness to travel as needed.

Nice To Haves

• Experience leading utilization management programs at a system level.
• Background in quality improvement, risk management, or compliance.
• Proficiency with electronic health records and UM platforms.

Responsibilities

• Lead and oversee the Utilization Management (UM) program across multiple facilities.
• Supervise and mentor UM nurses and NPs, ensuring consistency and quality in reviews and decisions.
• Review and approve requests for specialty referrals, diagnostics, and procedures to ensure medical necessity and cost-effectiveness.
• Monitor UM trends and collaborate with clinical leaders to improve efficiency and outcomes.
• Serve as the primary clinical liaison between site teams, corporate leadership, and external partners regarding UM processes.
• Ensure compliance with NCCHC/ACA standards, contract requirements, and state/federal regulations.
• Contribute to quality improvement initiatives and reporting.

Benefits

• Competitive health, prescription, dental, and vision insurance.
• Employment Assistance Program (EAP) services.
• 401(k) plan.
• Term life insurance at no cost to the employee.
• Paid time off (PTO) and paid holidays.
• Array of voluntary benefits.
• Prescriptions free of charge when filled at in-house pharmacy or mail order program.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Ambulatory Health Care Services
• Education Level: Master's degree