Director of Utilization Management, Prisons

Overview NaphCare  is hiring a Director Of Utilization, Prisons to join our team at the  Corporate Headquaters  located in  Birmingham, AL   NaphCare is a family owned, healthcare technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 35 years.  Come join our team of over 6000 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.   NaphCare Full Time Benefits: Prescriptions free of charge  through our health plan Health, dental & vision insurance that  starts day one ! We offer low-cost benefits to our employees and their families Employment Assistance Program (EAP) services 401K and Roth with company contribution that  starts day one! Tuition Assistance Referral bonuses On-site education Free Continuing Education! Term life insurance at no cost to the employee Generous paid time off & paid holidays 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. Responsibilities Responsibilities for Director Of Utilization, Prisons 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 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 Qualifications Qualifications for Director Of Utilization, Prisons : A current and unrestricted RN license  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 Valid CPR card