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Form of workNaphCare is seeking aUtilization Management Nurse-PRN at our corporate headquarters located in Birmingham, Alabama. The job reviews clinical charts to evaluate the medical necessity and appropriateness of off-site specialty visits, using our cutting-edge electronic health operating system. This position also performs case management for hospitalized patients.
This position will be remote but will require coming into the office at times. Residents only.
Position Requirements:
A current and unrestricted RN license in the state of employment with a minimum of 3 years' experience in an acute care setting and 2 years' experience in utilization review and/or case management. Excellent communication and interpersonal skills, attention to detail, and decision-making skills are essential. BSN or ADN required.
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 the need, if any, for intervention, and discuss with physicians.
- Review requests from providers regarding the 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 the medical necessity of requested services.
- Refers provider requests to the Medical Director or designee when the medical necessity of requested services does not meet recognized criteria.
We support your growth and internal promotion. Once hired, we encourage our employees to continue to seek opportunities for advancement and leadership.
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.
Equal Opportunity Employer: disability/veteran
