Job description
- Performs utilization review procedures by prospectively, concurrently, and retrospectively assessing the clinical information utilizing InterQual criteria, specialty guidelines, and protocols for admissions, observation, emergency care, surgical procedures and urgent clinic referrals.
- Monitors and facilitates appropriate utilization of resources and provides alternative options to hospital care (i.e., infirmary placement, urgent clinic).
- Collaborates with UTMB TDCJ Care Managers, Hospital Community Care Managers, TDCJ Bed Placement, and TDCJ Health Services, and internal and external agencies to facilitate care.
- Functions as a resource to physicians and nursing staff regarding approved criteria, specialty practice guidelines, and alternative treatment options.
- Provides 24/7 access to care and care coordination through the telephone call center. Shifts may be altered due to department business needs to cover 24 hours a day, 7 days a week operation.
- Collaborates with care managers, providers, nursing and pharmacy to facilitate identified discharge needs and ensure services provided at destination infirmary.
- Demonstrates knowledge of CMC Infirmary Criteria, CMC Nursing Needs, Medical and Support Services available at each infirmary, TDCJ Health Services Facility Types List, and CMC Formulary to determine admission to the appropriate infirmary.
- Adheres to internal controls established for department.
- Performs related duties as required.
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRRA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.
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