NaphCare - Birmingham, AL
posted 3 days ago
About the position
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.
Responsibilities
- Analyzing patient records after treatment is completed to identify potential areas for improvement in utilization management
- Evaluating pre-authorization requests for procedures, medications, or extended hospital stays to ensure they meet medical necessity criteria
- Determining whether a proposed treatment or procedure is clinically necessary based on established medical guidelines and the patient's specific condition
- Analyzing patient medical charts, lab results, and imaging studies to assess the appropriateness of requested care
- Maintaining knowledge of current medical practice standards and insurance coverage policies
- Evaluating appeals submitted by providers regarding denied claims
Requirements
- A current and unrestricted Physician's license in Alabama
- Significant experience in an acute care setting utilization review and/or case management
- Excellent communication and interpersonal skills
- Attention to detail and decision-making skills are essential
- Familiarity with Milliman and/or InterQual Care Guidelines preferred
Benefits
- Prescriptions free of charge through our health plan
- Health, dental & vision insurance that starts day one!
- Low-cost benefits to employees and their families
- Employment Assistance Program (EAP) services
- 100% vested 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
