Dir Utilization Mgmt CMC - Clear Lake Center - Full-Time in Galveston, Texas at University of Texas Medical Branch

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:

Responsible for the coordination and management of a full-service Utilization Management program to service the TDCJ, TJJD and other contracted inmate populations.

Scope:

Contribute to the success of UTMB and the (CMC) Correctional Managed Care Organization through the effective management of the CMC Utilization Management Program.

ESSENTIAL JOB FUNCTIONS:

• 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.

KNOWLEDGE/SKILLS/ABILITIES:

• 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

SUPERVISION:

Received: VP, Inpatient CMC & Admin Hospital Galveston

Given: UR Program Manager, Business Systems Analyst

BUDGET RESPONSIBILITY:

Direct: Responsible for the fiscal year department specific budget for CMC Utilization Management.

Indirect: Responsibility of the department budget has a direct effect on the overall CMC budget.

DECISION-MAKING RESPONSIBILITY:

Decisions include:

• Department personnel
• Department budget
• Development and continued review of department policies and procedures
• Quality and process improvement
• Data Analytics and recommendations to improve delivery of services.
• Effective use of evidence-based criteria in the continued performance of department Utilization Management.

EQUIPMENT:

Standard office equipment.

WORK ENVIRONMENT:

Standard office environment. May be required to work within the confines of a prison, jail, or juvenile detention center.

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

REQUIRED EDUCATION/EXPERIENCE:

• 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).

REQUIRED LICENSES, REGISTRATIONS OR CERTIFICATIONS

• Current unrestricted Texas RN License

PREFERRED EDUCATION/EXPERIENCE:

• 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.

PREFERRED LICENSES, REGISTRATIONS OR CERTIFICATIONS

• Certification for performance improvement

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 Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.