What are the responsibilities and job description for the Program Mgr UR/Case Management - CMC - Baybrook position at CMC - Baybrook - UTMB Health Careers?
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.
- 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 Utilization Review/Case Management work schedule to ensure adequate staff coverage and completion of all assignments.
- Develops and facilitates effective and efficient workflow processes for the Utilization Review/Case Management program according to established Policies and Procedures.
- Monitors and facilitates appropriate utilization of resources.
- Tracks and reports trends of inappropriate resource utilization to Director and/or Assistant Director of Utilization Review/Case Management.
- Maintains a documentation system of all review activities and enters appropriate variances using approved variance codes.
- Provides back-up support for telephone Utilization Review to ensure adequate staff coverage.
- Assists staff with problem resolution of Utilization Review issues.
- Provides leadership for the Utilization Review/Case Management program and promotes teamwork.
- Assists with the implementation of Utilization Review/Case Management Policies and Procedures.
- Assists in the orientation of new personnel and completes a formal preceptor plan in accordance with Utilization Management Policy 09.04.
- Identifies and facilitates quality improvement for the Utilization Review/Case Management program.
- Maintains a mechanism for the review of quality of care issues arising during concurrent review, and identifies areas of potential medical liability.
- Educates the Medical Staff and Nursing Staff on the Utilization Review/Case Management program and provides specific information related to case types, including financial data.
- Maintains clinical expertise in specialty area and/or general nursing.
- Provides assistance with clinical issues for non-nursing Utilization Review Case Management staff.
- Contributes to the overall success of UTMB Correctional Managed Care.
- Demonstrates a high level of productivity and dependability.
- Adheres to internal controls and reporting structure established for department.
- Performs related duties as required.
- Must be self-motivated, willing and able to learn multiple aspects of the job.
- Able to demonstrate both written and verbal communication skills.
- Demonstrate excellent interpersonal skills and telephone etiquette.
- Demonstrate history of accuracy, tenacity and attention to detail.
- May involve travel.
- May involve occasional shift work and weekends as needed to accommodate operations 24 hours a day, 7 days a week.
- Able to work under stress and be emotionally capable of coping with complex and/or changing activities.
- Bachelor's degree in Nursing (BSN) required. Graduation from an accredited school of Professional Nursing
- Current Texas Nursing Licensure as a Registered Nurse (RN).
- Minimum of five (5) years full-time wage earning experience as a professional nurse in a healthcare setting with at least two (2) years in the utilization review area and at least two (2) years of supervisory and/or management experience.
- Masters degree in Nursing (MSN) preferred.
Equal Employment Opportunity
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRRA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.