PRN Utilization Management Nurse Practitioner (NP)

NaphCare, Inc.

Birmingham (AL)

On-site

USD 83,000 - 124,000

Part time

4 days ago

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Benefits offered by this job

Health, dental & vision insurance (day

Prescriptions covered day one

401K with company contribution

Job summary

NaphCare is seeking a PRN Utilization Management Nurse Practitioner to join our medical team at the Birmingham, AL Corporate office. The NP will conduct utilization reviews, monitor care quality, and collaborate with physicians.

Required: active Arizona NP license and CPR. 3+ years in acute care and 2+ years in utilization review; familiarity with Milliman or Interqual guidelines is preferred.

Qualifications

Active NP license in Arizona (current and unrestricted)
CPR (AHA) required
Minimum 3 years in acute care and 2 years in utilization review/case management

Responsibilities

Perform utilization and concurrent review of patient cases.
Develop, implement, and administer QA and utilization review processes.
Monitor and report on the quality of medical care provided to patients.
Review requests from providers regarding medical necessity of services.
Refer non-qualifying cases to Medical Director or designee.

Skills

Nurse Practitioner skills

Communication

Attention to detail

Case management

CPR certification

Tools

Milliman guidelines

Interqual guidelines

Job description

PRN Utilization Management Nurse Practitioner (NP)

Job Details

ID: 2026-33064

Category: Provider Opportunities

Position Type: PRN

Location: US-AL-Birmingham

Overview

NaphCare is hiring a PRN, Utilization Management - Nurse Practitioner NP to join our team of medical professionals at the Corporate office in Birmingham, AL.

Responsibilities

Responsibilities for Utilization Management Nurse Practitioner (NP):

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.

Qualifications

Qualifications for Utilization Management Nurse Practitioner (NP):

A current and unrestricted Nurse Practitioner license in Arizona
A valid CPR card (AHA required)
A minimum of 3-years experience in an acute care setting and 2 years' experience in utilization review and/or case management.
Familiarity with Milliman or Interqual Care Guidelines is preferred
Excellent communication and interpersonal skills
Attention to detail and decision-making skills are essential

Why Join NaphCare?

NaphCare is one of the largest providers of healthcare services to correctional facilities throughout the US, and we are growing. If you have never considered a career in correctional healthcare, now may be the time! In addition to competitive salaries and generous employee benefits, we have opportunities for new graduates and experienced medical professionals, promote educational growth, and strongly support career advancement within the company.

NaphCare Benefits for Full-Time Employees Include: