Utilization Management Reviewer - This posting is open exclusively to current AL DOC incumbent employees.

Overview

This posting is open exclusively to current AL DOC incumbent employees

 

NaphCare Alabama Prisons LLC is hiring an experience Utilization Management Reviewer to join our team at the Regional Office in Alabama. 

Position Summary:

The Utilization Management Reviewer/ Manager performs technical and administrative work required to evaluate the necessity, appropriateness and efficiency of the use of medical services, procedures and facilities.  The UM Nurse has an emphasis on the review, analysis, monitoring, and operation of the patient medical care plans.

 

 Position Requirements:

A current and unrestricted RN license in the state of employment with a minimum of 6 years’ experience in an acute care setting and 4 years’ experience in utilization review and/or case management.  Excellent communication and interpersonal skills, attention to detail and decision-making skills are essential. BSN and familiarity with Milliman Care Guidelines preferred.

 

 Performance Expectations:

• 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 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 ofrequested services.
• Refers provider requests to Medical Director or designee when medical necessity of requested services does not meet recognized criteria.

 

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

 

Want a better idea of what it’s like to work in a jail? See what our RNs do:

NaphCare - Life as an RN - YouTube

 

If you would like to speak with me to learn more about this position and NaphCare, apply directly to the position to initiate the application process, and I’ll be in touch.

 

Equal Opportunity Employer: disability/veteran

 

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