Senior Director of Utilization Management

NaphCare

  • Birmingham, AL
  • Permanent
  • Full-time
  • 9 hours ago
Overviewhas an excellent opportunity for a Senior Director of Utilization Management to join our team at our Corporate Headquarters office located in Birmingham, AL.*This is an on-site position.is one of the largest providers of 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 for over 36 years.NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. Come join our growing team of 7,000 + 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 it’s like to work in correctional healthcare for the federal, state and local government?
😃Follow Us: | | |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

NaphCare