Dir Utilization Mgmt CMC - Clear Lake Center - Full-Time

UTMB•Galveston, TX

3d•Onsite

About The Position

Responsible for the coordination and management of a full-service Utilization Management program to service the TDCJ, TJJD and other contracted inmate populations. Contribute to the success of UTMB and the (CMC) Correctional Managed Care Organization through the effective management of the CMC Utilization Management Program.

Requirements

Graduate of accredited Registered Nursing program
Minimum of five years’ clinical experience in adult medical health care
Minimum of five years management experience in healthcare.
Minimum of four years of utilization management experience
Master’s degree (may be in non-related health care field).
Current unrestricted Texas RN License

Nice To Haves

Master's degree in Nursing, Healthcare Administration, Business Administration, Public Health, or related field.
Current CCM, ACM, CPHQ, or equivalent utilization management/quality certification.
Five (5) or more years of progressive leadership experience in utilization management, case management, managed care, or healthcare operations.
Experience in correctional healthcare, academic medical centers, or large integrated healthcare systems.
Advanced experience with InterQual and healthcare analytics platforms.
Demonstrated expertise in performance improvement, physician engagement, and utilization optimization initiatives.
Lean Six Sigma certification preferred.
Proven success leading large multidisciplinary teams and complex healthcare operations.
Certification for performance improvement

Responsibilities

Organize a staff of professionals to perform all aspects of both Utilization Review and Case Management in the Utilization Management Program.
Oversee the orientation program of staff to the Utilization Management methods, review, and the documentation process.
Acts as a resource to medical and security personnel at the prison level to the managed care process.
Oversee an ongoing quality assurance/ quality improvement program for the Utilization Management Department.
Responsible for the development of all the reporting and documentation needs for the Utilization Management Program.
Develop and maintain an ongoing process to evaluate and modify the Utilization Management program.
Continuous monitoring and improvement of reporting and documents to reflect the department’s productivity, patient population and opportunities for improvement and predictive analysis.
Responsible for the twenty-four-hour operation of the department to provide services to the CMC patient population.
Ensure effective fiscal responsible use of resources.
Adheres to internal controls and reporting structure established for department.
Performs other related duties as required.