Senior Director of Utilization Management (Nurse Practitioner)

About the role

NaphCare is seeking a Senior Director of Utilization Management to join our team at our Corporate Headquarters in Birmingham, AL. This is an on-site position with a company that has delivered high-quality healthcare to correctional facilities across the nation for over 36 years. As a family-owned healthcare technology company, NaphCare partners with correctional facilities to provide proactive, patient-focused care and employs over 7,000 team members.

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.

Requirements

• Licensed Nurse Practitioner (NP) with an 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.

Benefits

• Competitive health, prescription, dental, and vision insurance.
• Employment Assistance Program (EAP) services.
• 401(k) retirement plan.
• Term life insurance at no cost to the employee.
• Paid time off (PTO) and paid holidays.
• Array of voluntary benefits.
• Free prescriptions for employees enrolled in the health insurance program when filled at our in-house pharmacy or mail-order program.