Nurse Leader - Utilization Review Management

The University of Texas Medical Branch; Galveston (TX); Vor Ort; USD 90.000 - 120.000; Vollzeit

Zusammenfassung

The University of Texas Medical Branch in Galveston, TX seeks a Manager for Correctional Managed Care Utilization Review to lead daily UR operations and supervise UR Case Managers. The role focuses on delivering high-quality, cost-effective care within a correctional healthcare environment.

Responsibilities include staffing, policy implementation, performance improvement, crisis management, and acting as a clinical resource for guidelines.

Qualifikationen

• Graduate from an accredited school of professional nursing and currently Texas nursing licensure as a professional registered nurse.
• Minimum of five years full-time wage-earning experience as a professional nurse in a health care setting with at least two years in utilization review and/or case management experience.
• Two years of supervisory and/or management experience.

Aufgaben

• Supervise the operational management of the UR Utilization Review program to ensure high-quality, cost-effective service/outcomes and a safe work environment.
• Monitors the work performance of UR staff and provides guidance to achieve department and staff goals.
• Prepares department work schedules and timekeeping to ensure adequate coverage.
• Provides back-up UR coverage for telephone utilization review.
• Provides leadership to the department and promotes teamwork.
• Assists in UR policy and procedure implementation.
• Identifies needed SOPs, flow diagrams, and job aids.
• Orients new personnel to UR role and ensures full training.
• Acts as an expert resource for clinical guidance including InterQual and referral guidelines.
• Reviews quality of care issues and identifies potential medical liability.
• Contributes to the overall success of UTMB Correctional Managed Care.
• Adheres to internal controls and the department’s reporting structure.
• Performs other related duties as required.

Kenntnisse

Leadership/supervision

Team collaboration

Prioritization

Communication

Crisis management

Ausbildung

Texas RN license

Master’s degree (preferred)

Tools

InterQual

Jobbeschreibung

The University of Texas Medical Branch in Galveston, TX seeks a Manager for Correctional Managed Care Utilization Review to lead daily UR operations and supervise UR Case Managers. The role focuses on delivering high-quality, cost-effective care within a correctional healthcare environment.

Responsibilities include staffing, policy implementation, performance improvement, crisis management, and acting as a clinical resource for guidelines.