PRN-Utilization Management Registered Nurse

NaphCare; Birmingham; On-site; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Utilization Management Registered Nurse to join their team in Birmingham. This role is pivotal in ensuring quality healthcare delivery within correctional facilities. You will be responsible for developing quality assurance processes, conducting clinical assessments, and collaborating with physicians to ensure medical necessity. The company values growth and offers a supportive environment for internal promotion. If you're looking for a career that makes a difference and want to be part of a revolutionary healthcare team, this opportunity is for you.

Benefits

Outstanding Benefits

Continuing Education Opportunities

Internal Promotion Support

Qualifications

• 3+ years in acute care and 2+ years in utilization review/case management.
• Must have a current RN license in Alabama and valid CPR card.

Responsibilities

• Develop and administer quality assurance and utilization review processes.
• Monitor quality of medical care and perform utilization reviews.

Skills

Communication Skills

Attention to Detail

Decision-Making Skills

Education

BSN or ADN

Tools

Electronic Operating System

Job description

Overview

NaphCare is hiring experienced PRN-Utilization Management Registered Nurse just like you at the Corporate Headquarters located in Birmingham, Alabama.

NaphCare is a family-owned medical technology company that has been delivering high-quality healthcare to correctional facilities across the nation for over 30 years. Come join our team of over 4000 employees and growing! NaphCare pays well, offers outstanding benefits, and has an incredibly engaged corporate support team to make sure you have what you need to be truly excellent at what you do.

NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need. Be part of a world-class team of professionals who are revolutionizing correctional healthcare as you use our cutting-edge resources, including our award-winning electronic operating system.

NaphCare has a partnership with NetCE that provides CEU/CME for our staff. NetCE uses a rigorous peer review process to ensure that all activities and content are up-to-date. This service streamlines continuing education for all NaphCare Employees to meet state-specific requirements for maintaining licensing.

With NaphCare, you'll play a critical role in our continuing mission to be the leading provider of quality healthcare in the correctional industry. If you want a career that will make a difference, choose the company that is different.

We support your growth and internal promotion. Once hired, we encourage our employees to continue to seek opportunities for advancement and leadership.

Responsibilities

Responsibilities for Utilization Management Registered Nurse:

• 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.
• Review requests from providers regarding medical necessity of requested services for patients.
• Review and audit patients' medical records as indicated to determine medical necessity.
• Utilize nationally recognized criteria to determine medical necessity of requested services.
• Refer provider requests to Medical Director or designee when medical necessity of requested services does not meet recognized criteria.

Qualifications

Qualifications for Utilization Management Registered Nurse:

• A current and unrestricted RN license in Alabama.
• A minimum of 3 years’ experience in an acute care setting and 2 years’ experience in utilization review and/or case management.
• Valid CPR card.
• Excellent communication and interpersonal skills.
• Attention to detail and decision-making skills are essential.
• BSN or ADN required.
• Some travel required.

We know you may have questions before applying. To speak to a recruiter directly, email your questions and/or resume to [e-mail] with the position and location you’re interested in.

Equal Opportunity Employer: disability/veteran