Utilization Management Registered Nurse

NaphCare, Inc.; Phoenix (AZ); Remote; USD 65,000 - 90,000; Full time

Job summary

Join a forward-thinking company dedicated to revolutionizing correctional healthcare as a Utilization Management Registered Nurse. In this vital role, you'll be responsible for overseeing quality assurance and utilization review processes, ensuring that patients receive the best possible care. With a commitment to your professional growth and a supportive corporate team, you'll have the opportunity to make a significant impact in a unique healthcare setting. If you're looking for a career that truly makes a difference, this is the place for you.

Qualifications

• Current RN license in Arizona is required.
• 3+ years in acute care and 2+ years in utilization review.

Responsibilities

• Develop and administer quality assurance and utilization review processes.
• Monitor and report on the quality of medical care provided.

Skills

Utilization Review

Case Management

Communication Skills

Attention to Detail

Education

BSN or ADN

Job description

Utilization Management Registered Nurse

Location

US-AZ-Phoenix

ID

2025-21727

Category

Nursing

Position Type

Full-Time

Overview

NaphCare is hiring experienced Utilization Management Registered Nurse just like you at the Regional Headquaters (Remote).

NaphCare is a family owned, medical technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 35 years. Come join our team of over 6000 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 discussing with physicians
• Reviews requests from providers regarding 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 medical necessity of requested services
• Refers 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 Arizona
• 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.

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