Utilization Management Nurse Rn-Remote Alabama

The Utilization Management Nurse 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.

While this job is remote, the applicant still needs to be located in Alabama state for certain on-site workdays.

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. Some travel is 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 need, if any, for intervention, and discuss with physicians.

• Reviews 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 Medical Director or designee when medical necessity of requested services does not meet recognized criteria.

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.

Equal Opportunity Employer: disability/veteran