Director, Utilization Management - CMC - Clear Lake Center

UnitedHealth Group•Webster, TX

87d•Onsite

About The Position

The Director is responsible for the coordination and management of a full-service Utilization Management program to service the TDCJ, TJJD and other contracted inmate populations. 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). This role may be required to work within the confines of a prison, jail, or juvenile detention center.

Requirements

Master's Degree in related field plus five (5) years of progressive leadership and clinical experience in a healthcare environment to include four (4) years of utilization management experience.
Graduate of accredited Registered Nursing program with current unrestricted Texas RN License.
Strong data analysis skills
Performance Improvement expertise
Flexible and adept at managing a changing work environment
Superior people skills to interact with varied agencies, departments, and healthcare providers
Outstanding prioritization and organizational skills

Nice To Haves

Master's degree in Nursing, Healthcare Administration, Business Administration, Public Health, or related field plus five (5) or more years of progressive leadership experience in utilization management, case management, managed care, or healthcare operations in a correctional healthcare, academic medical center or large integrated healthcare system environment.
Current CCM, ACM, CPHQ, or equivalent utilization management/quality certification.
Advanced experience with InterQual and healthcare analytics platforms.
Demonstrated expertise in performance improvement, physician engagement, and utilization optimization initiatives.
Lean Six Sigma certification.
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.