Correctional Nurse -UT Rev- Utilization Management

Texas Tech University Health Sciences Center
United States, Texas, Lubbock
3601 4th Street (Show on map)
Jan 24, 2025
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 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 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. jeid-7df5dca89f0d9a4aaf96f0cb7f4ec098