Utilization Review Case MgrCMC (URCM) - Baybrook Office - Friendswood

Utilization Review Case MgrCMC (URCM) - Baybrook Office - Friendswood

Friendswood, Texas, United States

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 :

Supports the physician and interdisciplinary team in the provision of patient care (inpatient, outpatient, emergency and infirmary care) with the goal of enhancing quality clinical outcomes, promoting timely access to medical care, and managing care cost and efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions, all aspects of Infirmary Bed Management for (506 beds) in the Eastern Sector of Texas, and facilitation/coordination of hospital-to-hospital transfers for offenders in community hospital emergency rooms and community inpatient hospital beds in the Eastern Sector of Texas, and facilitation/coordination of hospital transfers from UTMB TDCJ Hospital to specialty services hospitals.

ESSENTIAL JOB FUNCTIONS :

• Performs utilization review procedures by prospectively, concurrently, and retrospectively assessing the clinical information utilizing InterQual criteria, specialty guidelines, and protocols for admissions, observation, emergency care, surgical procedures and urgent clinic referrals.
• Monitors and facilitates appropriate utilization of resources and provides alternative options to hospital care (i.e., infirmary placement, urgent clinic).
• Collaborates with UTMB TDCJ Care Managers, Hospital Community Care Managers, TDCJ Bed Placement, and TDCJ Health Services, and internal and external agencies to facilitate care.
• Functions as a resource to physicians and nursing staff regarding approved criteria, specialty practice guidelines, and alternative treatment options.
• Provides 24/7 access to care and care coordination through the telephone call center.
• Collaborates with care managers, providers, nursing and pharmacy to facilitate identified discharge needs and ensure services provided at destination infirmary.
• Demonstrates knowledge of CMC Infirmary Criteria, CMC Nursing Needs, Medical and Support Services available at each infirmary, TDCJ Health Services Facility Types List, and CMC Formulary to determine admission to the appropriate infirmary.
• Adheres to internal controls established for department.
• Performs related duties as required.

EQUIPMENT :

Standard office equipment.

WORK ENVIRONMENT :

Standard office environment. May involve shift work and weekends as needed to accommodate operations 24 hours a day, 7 days a week.

Security clearance is required; pre-employment drug testing is also required.

REQUIRED EDUCATION/EXPERIENCE :

Current Texas licensure as a Registered Nurse (RN) and a Bachelor's Degree in Nursing with a minimum of three (3) years full-time wage earning experience as a professional nurse in a hospital or healthcare setting.

Salary is commensurate with years of relevant work experience.

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.

Compensation