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Job Description
Correctional Nurse -UT Rev- Utilization Management
Managed Care HQ
39960BR
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.
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
- Comprehensive Benefits Package
- Training
- Continuing Education
- Loan Forgiveness Program
- Retiree Insurance
- Paid Leave
- Leadership Program
- State Pension
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.
To apply, please visit: https://sjobs.brassring.com/TGnewUI/Search/home/HomeWithPreLoad?partnerid=25898&siteid=5283&PageType=JobDetails&jobid=882957
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.
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. You can locate this report through our website at: https://www.ttuhsc.edu/emergency/clery-report.aspx.
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ABOUT THE COMPANY
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Texas Tech University Health Sciences Center
Show moreAbout Us
Nationally recognized for innovative programs, academic achievement, cutting-edge research and exceptional patient care, Texas Tech University Health Sciences Center aims to promote a greater health environment for West Texas and beyond. While our flagship campus resides proudly in Lubbock, Texas, TTUHSC operates five schools with campuses in Abilene, Amarillo, Dallas/Fort Worth, Lubbock and the Permian Basin (Midland & Odessa).
Like Texas itself, we are an independent and proud institution that is part of a larger union, the Texas Tech University System. As a university separate from Texas Tech University, we have been entrusted with a singular charge: to teach the next generation of doctors, nurses, pharmacists, researchers and health care professionals while simultaneously providing the people of West Texas with world-class patient care. We are both an institution of higher learning and a place where real people come for life-saving medical care.
Our Mission
As a comprehensive health sciences center, our mission is to enrich the lives of others by educating students to become collaborative health care professionals, providing excellent patient care, and advancing knowledge through innovative research.
Our Values & Culture
Through our values-based culture, TTUHSC is committed to cultivating an exceptional workplace community with a positive culture that puts people first. Our five values guide our actions and principles: Beyond Service, Kindhearted, Integrity, One Team, and Visionary.
Compensation & Benefits
We are proud to offer many exceptional employee benefits, including a generous compensation package with comprehensive benefits, medical and dental insurance, paid time off and substantial automatic retirement contributions. Additionally, we invest in employee success by providing many resources designed to support your personal and professional growth, including:
- Comprehensive Health Plans and Other Core Insurance
- State Retirement Programs and Pension Options
- Retiree Insurance for Lifetime Medical Benefits
- Continuing Education & Lifelong Learning Programs
- Tuition scholarships for employees and their dependents
- Leadership and Professional Development Programs
- Mental and Physical Wellness Programs
- Employee Recognition Programs and Longevity Pay
We are excited for you to consider joining our team at the Texas Tech University Health Sciences Center. Consistently ranked as a "Great College to Work For" by the Chronicle of Higher Education, TTUHSC provides so much more than just a job!
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