Senior Director of Utilization Management (Nurse Practitioner)
On-siteBirmingham, Alabama, United States
Job Summary
Lead and oversee the Utilization Management program across multiple correctional facilities, supervising a team of UM nurses and NPs to ensure consistency in reviews and decisions. Review and approve requests for specialty referrals, diagnostics, and procedures to guarantee medical necessity and cost-effectiveness while monitoring trends to improve efficiency and outcomes. Serve as the primary clinical liaison between site teams, corporate leadership, and external partners, ensuring full compliance with NCCHC/ACA standards, contract requirements, and state/federal regulations. Contribute to quality improvement initiatives and reporting to support proactive, patient-focused healthcare delivery.
Required Qualifications
- Licensed Nurse Practitioner (NP) with active, unrestricted license
- 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
Desired Qualifications
- Correctional healthcare experience strongly preferred
- 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
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