Utilization Management Reviewer - This posting is open exclusively to current AL DOC incumbent employees.

Job description

Overview This posting is open exclusively to current AL DOC incumbent employees NaphCare Alabama Prisons LLC is hiring an experience Utilization Management Reviewer to join our team at the Regional Office in Alabama. Position Summary: The Utilization Management Reviewer/ Manager 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. Position Requirements: A current and unrestricted RN license in the state of employment with 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. BSN and familiarity with Milliman Care Guidelines preferred. 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...