Manager Utilization Review/Case Management CMC - Carole Young
About The Position
Correctional Managed Care’s mission is to address the healthcare needs of underserved patient populations within the Texas Department of Criminal Justice and the Texas Juvenile Justice Department. The Manager of Utilization Review is responsible for daily department operations and managing Utilization Review Case Managers to support effective department operations, exceptional customer service, and patient support. The manager oversees the operational management of the Utilization Review program to provide high-quality, cost-effective outcomes in a safe and efficient work environment. The role monitors staff performance, provides guidance, manages scheduling and timekeeping, supports telephone utilization review coverage, helps implement policies and procedures, and leads staff orientation and integration. The manager also serves as an expert resource on clinical resources and guidelines, reviews quality-of-care concerns and potential medical liability, and contributes to department performance improvement and success. The position reports to the Director, CMC Utilization Review, and supervises Utilization Review Case Managers. It involves decision-making related to budgets, personnel, data analysis and planning, emergency management, and quality improvement. The work takes place in a standard office environment and may require working in a prison, jail, or juvenile detention center. Security clearance and pre-employment drug testing are required.
Requirements
- Graduate of an accredited school of professional nursing.
- Currently hold an active and valid Texas professional registered nurse license.
- At least five years of full-time, wage-earning professional nursing experience in a healthcare setting.
- At least two years of utilization review and/or case management experience.
- At least two years of supervisory and/or management experience.
- Demonstrated collaboration, professionalism, and ability to work with healthcare providers and staff.
- Ability to learn multiple aspects of the job and take initiative.
- Ability to manage crisis situations professionally and effectively.
- Skill in prioritizing work and communicating clinical issues to non-nursing utilization review staff.
- Security clearance is required.
- Pre-employment drug testing is required.
Nice To Haves
- Master’s degree.
- At least three years of adult care nursing experience.
Responsibilities
- Supervise operational management of the Utilization Review program to ensure high-quality, cost-effective service and outcomes and a safe, efficient work environment.
- Monitor Utilization Review Case Manager performance and provide guidance or intervention to help staff achieve department and individual goals.
- Prepare department work schedules and manage timekeeping to ensure adequate staffing and completion of work.
- Provide backup telephone Utilization Review support to ensure adequate staff coverage.
- Provide leadership and promote teamwork within the department.
- Assist with implementing Utilization Review policies and procedures.
- Help identify department standard operating procedures, flow diagrams, and job aids that are needed.
- Orient new personnel and integrate them into the department as fully trained Utilization Review Case Managers.
- Serve as an expert resource for clinical resources, including Optum (InterQual) and Urgent Referral guidelines, as well as other resources defined by CMC.
- Review quality-of-care issues arising during department duties and identify potential medical liability.
- Contribute to the overall success of UTMB Correctional Managed Care.
- Adhere to department internal controls and reporting structure.
- Remain current on job-related knowledge, skills, and applicable in-service or certification requirements.
- Learn multiple aspects of the job and perform marginal clerical duties as needed.
- Collaborate professionally with healthcare providers and staff.
- Manage crisis situations professionally and effectively, prioritize work, and communicate clinical issues effectively to non-nursing utilization review staff.
- Participate in performance improvement and lead efforts to achieve department goals.
- Perform other related duties as required.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
