Utilization Management Registered Nurse

NaphCare; Phoenix (AZ); Remote; USD 65,000 - 95,000; Full time

Job summary

Join a forward-thinking company that has been a leader in correctional healthcare for over 35 years. As a Utilization Management Registered Nurse, you will play a crucial role in ensuring quality patient care through effective utilization review processes. This position offers the chance to work remotely while being part of a dedicated team committed to excellence in healthcare. With opportunities for professional growth and a supportive corporate environment, you will be empowered to make a difference in the lives of diverse patient populations. If you are passionate about healthcare and looking for a meaningful career, this is the perfect opportunity for you.

Benefits

Competitive Pay

Outstanding Benefits

CEU/CME Opportunities

Internal Promotion Opportunities

Qualifications

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

Responsibilities

• Oversee quality assurance and utilization review processes.
• Monitor quality of medical care provided to patients.
• Conduct clinical chart assessments and audits.

Skills

Utilization Review

Case Management

Communication Skills

Attention to Detail

Decision-Making Skills

Education

BSN or ADN

Job description

Overview

NaphCare is hiring experienced Utilization Management Registered Nurse at the Regional Headquarters (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. Join our team of over 6,000 employees and growing! We offer competitive pay, outstanding benefits, and a highly engaged corporate support team to help you excel in your role.

We partner with correctional facilities to provide proactive, patient-focused healthcare. Our onsite teams take pride in serving a diverse patient population and delivering excellence in care, supported by cutting-edge resources including our award-winning electronic operating system.

NaphCare also partners with NetCE to provide CEU/CME opportunities for our staff, ensuring all activities meet current standards through a rigorous peer review process. This streamlines continuing education to help maintain your licensing requirements.

With NaphCare, you'll play a vital role in our mission to be the leading provider of quality healthcare in the correctional industry. If you're looking for a meaningful career, join a company that makes a difference.

We support your growth and internal promotion. Once hired, we encourage ongoing opportunities for advancement and leadership.

Responsibilities

Responsibilities for Utilization Management Registered Nurse:

• Develop, implement, and oversee quality assurance and utilization review processes.
• Monitor and report on the quality of all aspects 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 the need for intervention and discuss with physicians as necessary.
• Review provider requests regarding medical necessity of services.
• Audit patients' medical records to determine medical necessity.
• Use nationally recognized criteria to assess medical necessity.
• Refer provider requests that do not meet recognized criteria to the Medical Director or designee.

Qualifications

Qualifications for Utilization Management Registered Nurse:

• Current and unrestricted RN license in Arizona.
• At least 3 years of experience in an acute care setting and 2 years in utilization review and/or case management.
• Valid CPR certification.
• Excellent communication and interpersonal skills.
• Attention to detail and decision-making skills are essential.
• BSN or ADN required.

If you have questions before applying, please contact a recruiter directly by emailing your questions and/or resume to [e-mail] with the position and location of interest.

Equal Opportunity Employer: disability/veteran