PRN Utilization Managment Registered Nurse

NaphCare is a family owned, medical technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 30 years. Come join our team of over 4000 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.

NaphCare is hiring experienced PRN-Utilization Management Registered Nurse just like you at the Corporate Headquarters located in Birmingham, Alabama.

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