Utilization Management Registered Nurse - Remote - Arizona
About The Position
NaphCare is hiring an experienced Utilization Management Registered Nurse to join its remote-based Arizona team. NaphCare is a family-owned healthcare technology company that has provided healthcare to correctional facilities across the nation for more than 35 years. The company partners with correctional facilities to provide proactive, patient-focused healthcare and supports employee growth and internal promotion. In this role, the nurse develops and administers quality assurance and utilization review processes, evaluates the quality of medical care, reviews patient cases and records, and assesses whether requested services are medically necessary. The role requires an Arizona RN license, relevant acute-care and utilization review or case-management experience, and some travel. The stated physical capabilities include standing for long periods and performing physically demanding tasks.
Requirements
- Current and unrestricted RN license in Arizona.
- At least 3 years of experience in an acute-care setting.
- At least 2 years of experience in utilization review and/or case management.
- Valid CPR card.
- Excellent communication and interpersonal skills.
- Attention to detail and decision-making skills.
- BSN or ADN required.
- Some travel required.
Responsibilities
- 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.
- Perform utilization and concurrent review of patient cases.
- Conduct detailed clinical chart assessments.
- Gather clinical information to assess and expedite care needs.
- Determine whether intervention is needed and discuss it with physicians.
- Review provider requests regarding the medical necessity of requested patient services.
- Review and audit patient medical records as indicated to determine medical necessity.
- Use nationally recognized criteria to determine the medical necessity of requested services.
- Refer provider requests to the Medical Director or designee when requested services do not meet recognized medical-necessity criteria.
Benefits
- Health, dental, and vision insurance starting on day one.
- Prescriptions at no charge through the health plan, beginning on day one.
- 401(k) and Roth plans with a company contribution starting on day one.
- Tuition assistance.
- Referral bonuses.
- Term life insurance at no cost to the employee.
- Generous paid time off and paid holidays.
- Free continuing education and CMEs.
- Employee Assistance Program services.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
