NaphCare is currently in search of a skilled Medical Director to join our team at the Corporate Headquarters in Birmingham, AL. The ideal candidate will have previous experience in managing utilization for a prominent healthcare insurance provider.
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 5000 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 planHealth, dental & vision insurance that starts day one!We offer low-cost benefits to our employees and their familiesEmployment Assistance Program (EAP) services100% vested 401K and Roth with company contribution that starts day one!Tuition AssistanceReferral bonusesOn-site educationFree Continuing Education!Term life insurance at no cost to the employeeGenerous 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.
ResponsibilitiesResponsibilities for Utilization Management Manager:
Analyzing patient records after treatment is completed to identify potential areas for improvement in utilization managementEvaluating pre-authorization requests for procedures, medications, or extended hospital stays to ensure they meet medical necessity criteriaDetermining whether a proposed treatment or procedure is clinically necessary based on established medical guidelines and the patient's specific conditionAnalyzing patient medical charts, lab results, and imaging studies to assess the appropriateness of requested careMaintaining knowledge of current medical practice standards and insurance coverage policiesEvaluating appeals submitted by providers regarding denied claims Qualifications
Qualifications for Utilization Management Manager:
A current and unrestricted Physician's license in AlabamaSignificant experience in an acute care setting utilization review and/or case managementExcellent communication and interpersonal skillsAttention to detail and decision-making skills are essentialFamiliarity with Milliman and/or InterQual Care Guidelines preferredWe know you may have questions before applying. To speak to a recruiter directly, email your questions and/or resume to CorporateHR@naphcare.com with the position and location you’re interested in.
Equal Opportunity Employer: disability/veteran
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