Utilization Management Nurse Practitioner (NP)

NaphCare, Inc.; Birmingham (AL); On-site; USD 83,000 - 124,000; Part time

Job summary

NaphCare is hiring a PRN Utilization Management Nurse Practitioner (NP) to join our team at the Corporate office in Birmingham, AL. This role reviews clinical charts to evaluate medical necessity and coordinates case management for hospitalized patients.

As an Utilization Management NP, you will apply national criteria, perform chart reviews, and discuss care plans with physicians to ensure appropriate care. This is a meaningful opportunity in correctional healthcare.

Qualifications

• A current and unrestricted NP license in AZ.
• A valid CPR (AHA) certification.
• Minimum 3 years in acute care and 2 years in utilization review/case management.
• Familiarity with Milliman or InterQual guidelines preferred.
• Excellent communication and interpersonal skills.
• Attention to detail and decisive judgment.

Responsibilities

• Review clinical charts to evaluate medical necessity of off-site specialty visits.
• Perform utilization and concurrent review of patient cases.
• Gather clinical information to assess and expedite care needs.
• Determine need for intervention and discuss with physicians.
• Review provider requests and audits of medical records for necessity.

Skills

NP License (AZ)

CPR (AHA)

Acute care experience (3+ yrs)

Utilization review / case management (

Job description

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?

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

• 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

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