Utilization Management NP – PRN Case Review Specialist

Naphcare, Inc.; Edgemont (AL); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401K and Roth

Tuition assistance

Referral bonuses

Life insurance

Paid time off

CME

Job summary

NaphCare, Inc. is hiring a PRN Utilization Management Nurse Practitioner (NP) to join our team at the Corporate office in Birmingham, AL. The NP will review clinical charts to evaluate medical necessity for off-site visits and perform case management for hospitalized patients.

This role offers the chance to impact a diverse patient population with complex needs while working within our Utilization Management team.

Qualifications

• 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.

Responsibilities

• Understand the principles of medical quality assurance and utilization review.
• Develop, implement, and administer quality assurance 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 requested services.
• Review and 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 not met.

Skills

Communication

Interpersonal skills

Attention to detail

Decision making

Job description

NaphCare, Inc. is hiring a PRN Utilization Management Nurse Practitioner (NP) to join our team at the Corporate office in Birmingham, AL. The NP will review clinical charts to evaluate medical necessity for off-site visits and perform case management for hospitalized patients.

This role offers the chance to impact a diverse patient population with complex needs while working within our Utilization Management team.