PRN Utilization Management Nurse Practitioner (NP)

NaphCare is hiring a PRN Utilization Management (UM) Nurse Practitioner to join our Utilization Management team in a remote capacity located at our Corporate Headquarters in Birmingham, AL.

As a PRN Utilization Management (UM) Nurse Practitioner you will work with our client-site medical staff to help them to evaluate treatment plans against established guidelines and contract requirement and reviews patient clinical charts to determine the medical necessity and appropriateness of off-site specialty visits. This work focuses on case reviews, documentation, communications and collaboration with other healthcare professionals.

The PRN Utilization Management (UM) Nurse Practitioner reviews clinical charts to evaluate the medical necessity and appropriateness of off-site specialty visits. Responsibilities may include and not be limited to:

Performing case management for hospitalized patients
• Examining patient charts and medical records to assess the appropriateness and medical necessity of treatments and procedures
• Evaluating whether the level of care and services provided are justified based on established guidelines and clinical criteria
• Making sure that healthcare services adhere to established guidelines, contract requirements, and internal policies
• Interacting with physicians and site staff to clarify or appeal decisions
• Communicating clinical information and criteria to relevant parties
• Suggesting more appropriate or cost-effective treatment options when necessary
• Identifying opportunities to improve the efficiency and effectiveness of healthcare resource allocation
• Maintaining accurate records of reviews, decisions, and recommendations

Experience / Requirements / Qualifications

• A current and unrestricted NP license
• BSN or ADN required

• Possess an active CPR certification

• A minimum of 1-year experience in an acute care setting
• Familiarity with Milliman or InterQual Care Guidelines is preferred
• Attention to detail and decision-making skills are essential
• Ability to maintain confidentiality of all proprietary and/or confidential information
• Excellent interpersonal communication skills are essential for interacting with other medical professionals
• Ability to work independently
• Integrity, professionalism and ability to adhere to a Code of Conduct and comply with all facility(s) correctional healthcare policies, procedures, and legal requirements
• Must pass drug screening

Physical Capabilities:

Must have the ability to stand for long periods, lift and move patients (up to 50 pounds), bend, squat, reach, push, pull, walk significant distances, and perform physically demanding tasks like CPR, all while maintaining good balance and endurance throughout a shift.

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

If you would like to speak with me to learn more about this position and NaphCare, please first apply directly to the position to initiate the application process, then send your resume to courtney.herald@naphcare.com and I'll be in touch.

Equal Opportunity Employer: disability/veteran

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