Utilization Management Nurse Practitioner (NP)
NaphCare•Birmingham, AL
•Onsite
About The Position
NaphCare is hiring a Full Time, Utilization Management - Nurse Practitioner NP to join our team of medical professionals at the Corporate office in Birmingham, AL. As a Utilization Management - Nurse Practitioner NP, you will review clinical charts to evaluate the medical necessity and appropriateness of off-site specialty visits and also perform case management for hospitalized patients. This is a unique position where you can make a difference to this diverse population of patients with complex medical needs.
Requirements
- A current and unrestricted Nurse Practitioner license in Arizona
- A valid CPR card (AHA )
- A minimum of 3-years experience in an acute care setting
- 2 years' experience in utilization review and/or case management.
- Excellent communication and interpersonal skills
- Attention to detail and decision-making skills are essential
Nice To Haves
- Familiarity with Milliman or Interqual Care Guidelines is preferred
Responsibilities
- Understanding of the principles and concepts of medical quality assurance and utilization review.
- 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 discuss with physicians.
- Reviews requests from providers regarding the 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 the medical necessity of requested services.
- Refers provider requests to the Medical Director or designee when the 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
