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

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.

EQUI