Job Description

Program Mgr UR/Case Management - CMC - Clear Lake Center Join to apply for the Program Mgr UR/Case Management - CMC - Clear Lake Center role at The University of Texas Medical Branch Program Mgr UR/Case Management - CMC - Clear Lake Center 2 weeks ago Be among the first 25 applicants Join to apply for the Program Mgr UR/Case Management - CMC - Clear Lake Center role at The University of Texas Medical Branch The mission of Correctional Managed Care is to address the healthcare needs of underserved patient populations within the Texas Department of Criminal Justice (TDCJ) and the Texas Juvenile Justice Department (TJJD). JOB SUMMARY : To provide 24-hour accountability for the operational and personnel management of the UTMB UR/CM program. Serves as liaison and assists in the resolution of issues that cross multiple departments and/or services to ensure optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review/Case Management program by utilizing clinical knowledge, expertise, approved criteria, protocols and guidelines to ensure care is appropriate and provided in a cost-effective manner. ESSENTIAL JOB FUNCTIONS : Supervises the operational management of the Utilization Review/Case Management program to ensure high quality, cost-effective service/outcomes, and a safe and efficient work environment. Monitors the work performance of the Utilization Review Case Management staff and provides guidance as necessary. Prepares the work schedule to ensure adequate staff coverage and completion of all assignments. Develops and facilitates workflow processes according to established Policies and Procedures. Monitors resource utilization and reports trends of inappropriate use to leadership. Maintains documentation of review activities and enters variances using approved codes. Provides backup support for telephone Utilization Review to ensure coverage. Assists staff with problem resolution related to Utilization Review issues. Provides leadership and promotes teamwork within the program. Assists with policy implementation and staff orientation. Identifies and facilitates quality improvement initiatives. Maintains review of care quality issues and medical liability concerns. Educates staff and medical personnel on the Utilization Review/Case Management program, including financial aspects. Maintains clinical expertise and provides clinical support for staff. Contributes to the success of UTMB Correctional Managed Care and demonstrates dependability. Adheres to internal controls and reporting structures. Performs related duties as required. KNOWLEDGE/SKILLS/ABILITIES : Self-motivated with the ability to learn multiple aspects of the role. Strong written and verbal communication skills. Excellent interpersonal skills and telephone etiquette. Attention to accuracy, detail, and persistence. EQUIPMENT : Standard office equipment. WORK ENVIRONMENT : May involve travel and occasional shift work including weekends. Ability to work under stress and adapt to changing activities. Security clearance and pre-employment drug testing are required. REQUIRED EDUCATION/EXPERIENCE : Bachelor's degree in Nursing (BSN) from an accredited school. Current Texas RN licensure. Minimum of 5 years full-time nursing experience, including 2 years in utilization review and 2 years in supervisory/management roles. PREFERRED EDUCATION/EXPERIENCE : Master's degree in Nursing (MSN) preferred. Salary is commensurate with experience. #J-18808-Ljbffr The University of Texas Medical Branch

Job Tags

Full time, Casual work, Shift work,

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