Utilization Review Case MgrCMC (UR) - Baybrook Office - Friendswood
Company: University of Texas Medical Branch
Posted on: June 12, 2021
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).
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.
Standard office equipment.
Standard office environment. May involve shift work and weekends
as needed to accommodate operations 24 hours a day, 7 days a
Security clearance is required; pre-employment drug testing is
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
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
Keywords: University of Texas Medical Branch, Galveston , Utilization Review Case MgrCMC (UR) - Baybrook Office - Friendswood, Other , Galveston, Texas
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