OverviewNaphCare is hiring a Director Of Utilization, Prisons to join our team at the Corporate Headquaters located in Birmingham, AL
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
