PRN Utilization Management Nurse Practitioner (NP)

Naphcare, Inc.; Edgemont (AL); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health, dental & vision insurance

401K plan with company contribution

Tuition Assistance

Employee Assistance Program (EAP)

Paid time off and holidays

Free CMEs / continuing education

Job summary

NaphCareis hiring a PRN Utilization Management Nurse Practitioner (NP) to join our corporate team at the Birmingham, AL office. You will review clinical charts to evaluate medical necessity and appropriateness of off-site specialty visits, and perform case management for hospitalized patients.

This unique role supports diverse patients with complex medical needs and emphasizes quality assurance, utilization review, and collaboration with physicians to optimize care.

Qualifications

• Current and unrestricted NP license in Arizona.
• A valid CPR card (AHA required).
• Minimum of 3 years acute care and 2 years in utilization review / case management.
• Familiarity with Milliman or InterQual Care Guidelines preferred.
• Excellent communication and interpersonal skills.
• Attention to detail and decision‑making skills are essential.

Responsibilities

• Understand medical quality assurance and utilization review principles.
• Develop, implement, and administer QA and utilization review processes.
• Monitor and report on the quality 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 need for intervention and discuss with physicians.
• Review requests from providers regarding medical necessity of services.
• Audit patients' medical records to determine medical necessity.
• Utilize nationally recognized criteria to determine medical necessity.
• Refer provider requests to Medical Director when criteria are unmet.

Skills

Unrestricted NP license

CPR certification

Clinical chart review

Utilization review

Communication skills

Attention to detail

Tools

Milliman guidelines

InterQual guidelines

Job description

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.

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.

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?

NaphCareis 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, andstrongly support career advancement within the company.

NaphCare Benefits for Full-Time Employees Include:

• 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

Equal Opportunity Employer: disability/veteran