Utilization Management Registered Nurse - Remote - Arizona

NaphCare • Phoenix, AZ

2d • Remote

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 nationwide for over 35 years. The company partners with correctional facilities to provide proactive, patient-focused healthcare and supports employee growth and internal advancement.

The nurse develops and administers quality assurance and utilization review processes, assesses clinical records and service requests for medical necessity, and helps determine and expedite patient care needs. The role requires an Arizona RN license, acute-care and utilization-review or case-management experience, and an ADN or BSN. Some travel is required, and the job includes physical demands such as lifting and moving patients up to 50 pounds and performing CPR.

Requirements

• Current, 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.
• Ability to stand for long periods; lift and move patients up to 50 pounds; bend, squat, reach, push, pull, and walk significant distances; and perform physically demanding tasks such as CPR while maintaining balance and endurance throughout a shift.

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 the requested services do not meet recognized medical-necessity criteria.

Benefits

• Health, dental, and vision insurance beginning day one.
• Prescriptions at no charge through the health plan, beginning day one.
• Employee Assistance Program (EAP) services.
• 401(k) and Roth plans with company contribution beginning 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.
• NetCE continuing education access for CEU/CME and licensing requirements.
• Career advancement and internal promotion support.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree