Senior Director of Utilization Management (Nurse Practitioner)

Birmingham, MI - USA

Monthly Salary: Not Disclosed

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

Overview

NaphCarehas an excellent opportunity for a Senior Director of Utilization Management to join our team at our Corporate Headquarters office locatedinBirmingham AL.

*This is an on-site position.

NaphCareisone of the largest providersof healthcare services to correctional facilities throughout the United States. NaphCare is a family owned healthcare technology company that has been delivering high quality healthcare to correctional facilities across the nation forover36 years.

NaphCare partners with correctional facilities to provide proactive patient-focused join our growing team of7000 employees!

The Senior Director of Utilization Management (Sr. UM) will provide leadership and oversight of utilization management processes across our correctional healthcare system. This individual must be a licensed Nurse Practitioner (NP) with correctional healthcare experience strongly preferred who will supervise a team of UM nurses and NPs. The Sr. UM will ensure appropriate use of medical services streamline clinical workflows and uphold compliance with standards and contractual requirements.

Responsibilities

Lead and oversee the Utilization Management (UM) program across multiple facilities.
Supervise and mentor UM nurses and NPs ensuring consistency and quality in reviews and decisions.
Review and approve requests for specialty referrals diagnostics and procedures to ensure medical necessity and cost-effectiveness.
Monitor UM trends and collaborate with clinical leaders to improve efficiency and outcomes.
Serve as the primary clinical liaison between site teams corporate leadership and external partners regarding UM processes.
Ensure compliance with NCCHC/ACA standards contract requirements and state/federal regulations.
Contribute to quality improvement initiatives and reporting.

Qualifications

Licensed Nurse Practitioner (NP) with active unrestricted license.
Correctional healthcare experience strongly preferred.
Demonstrated expertise in Utilization Management and care coordination.
Strong leadership and team management skills with the ability to supervise clinical staff across multiple locations.
Excellent communication analytical and decision-making skills.
Familiarity with NCCHC/ACA standards and correctional healthcare regulations.
Willingness to travel as needed.

Preferred Qualifications

Experience leading utilization management programs at a system level.
Background in quality improvement risk management or compliance.
Proficiency with electronic health records and UM platforms.

NaphCare Benefits Package:

NaphCare offers competitive benefits including health prescription dental vision Employment Assistance Program (EAP) services and 401(k). NaphCare offers term life insurance at no cost to the employee and also provides PTO paid holidays and an array of voluntary benefits. Employees enrolled in our health insurance program receive prescriptions free of charge when filled at our in-house pharmacy or mail order program.

Want a better idea of what its like to work in correctional healthcare for thefederal state and local government

Life at NaphCare: Inside Correctional Healthcare: Care That Makes a Difference
Life at NaphCare: Autonomy
Life at NaphCare: Safety
Life at NaphCare: Skill Building & Professional Development Opportunities
Life at NaphCare - Life as a NaphCare Nurse Practitioner
NaphCare - Life as an LPN - YouTube

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities skills efforts or working conditions associated with a job.

Please note the duties and responsibilities listed are subject to change based on the needs of the organization.

Equal Opportunity Employer: disability/veteran

Required Experience:

Exec

OverviewNaphCarehas an excellent opportunity for a Senior Director of Utilization Management to join our team at our Corporate Headquarters office locatedinBirmingham AL.*This is an on-site position.NaphCareisone of the largest providersof healthcare services to correctional facilities throughout th...