Correctional Nurse -UT Rev- Utilization Management

Position Description

Employees in this classification perform technical and administrative work required to monitor and evaluate the quality and appropriateness of medical claims submitted for health services provided for inmates. Provides technical guidance to subordinate utilization review staff and other clinic personnel and outside professionals.

Pay Grade Maximum

Compensation is commensurate upon the qualifications of the individual selected and budgetary guidelines of the hiring department, as well as the institutional pay plan.

Major/Essential Functions
? Implements utilization review procedures, screens records against pre-established criteria to determine necessity of services, develops reports of quality of care audits, and identifies areas of potential medical liability.
? Maintains a mechanism for the review of quality care issues arising during concurrent review.
? Receives, reviews, and monitors medical claims for appropriate charges utilizing various payment systems initiates reimbursement for medical claims for health services provided for inmates.
? Provides liaison and coordinates work with hospital facilities and physicians' billing departments.
? Provides technical guidance to subordinate utilization review staff.
? Performs other duties as required.

About Managed Care

Since 1989, TTUHSC Managed Care has served as a healthcare delivery service, providing high quality, low cost healthcare to patients within the Texas Department of Criminal Justice system. We provide medical, mental health, and dental services to patients in 22 facilities throughout West Texas. Managed Care emphasizes our values-based culture in all we do. You can learn more about TTUHSC Managed Care by visiting our website HERE.

This valuable team member shall perform work in a manner that reflects the Values of TTUHSC:
? ONE TEAM: Unite and include diverse perspectives to achieve our mission
? KINDHEARTED: Exceed expectations with a kind heart, helping hands, and a positive attitude
? INTEGRITY: Be honorable and trustworthy even when no one is looking
? VISIONARY: Nurture innovative ideas, bold explorations, and a pioneering spirit
? BEYOND SERVICE: Create and deliver positive defining moments

Take care of yourself and your family. Enjoy some of the best benefits in the state of Texas:
? Comprehensive Benefits Package
? Training
? Continuing Education
? Loan Forgiveness Program
? Retiree Insurance
? Paid Leave
? Leadership Program
? State Pension

Pay Grade Minimum

Compensation is commensurate upon the qualifications of the individual selected and budgetary guidelines of the hiring department, as well as the institutional pay plan.

Pay Statement

Compensation is commensurate upon the qualifications of the individual selected and budgetary guidelines of the hiring department, as well as the institutional pay plan. For additional information, please reference the institutional pay plan website.

EEO Statement

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, age, disability, genetic information or status as a protected veteran.

Required Qualifications

Graduated from an approved accredited nursing program; current RN License as approved by the Texas State Board of Nursing or ability to transfer current RN license to Texas. Three years of full-time wage earning experience as a professional nurse in a health care setting.

Jeanne Clery Act

The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act is a federal statute requiring colleges and universities participating in federal financial aid programs to maintain and disclose campus crime statistics and security information. By October 1 of each year, institutions must publish and distribute their Annual Campus Security Policy & Crime Statistics Report (ASR) to current and prospective students and employees. To view this report, visit the TTUHSC Clery Act website.

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