Utilization Mgmt Speech Spec

 
Position: Utilization Mgmt Speech Spec

Job ID: 145122

Location: US-TX-Bellaire

Department: Utilization Management

Talent Area: Professional - Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: Days

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are searching for a Clinical Nurse Coordinator, someone who can work well in a fast-paced health care environment. In this position you’ll manage daily clinical and personnel activities for the Department. You will also participate and coordinate the delivery of high quality, family centered and developmentally appropriate patient care.

 

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Responsibilities :

  • Assess the treatment plan, clinical information, and medical necessity of all requested services
  • Utilizes established criteria to appropriately certify requested services within established timeframe required Facilitates provider communication and education
  • Notifies providers of approved services verbally and through written correspondence Liaisons with internal and external managed care staff members
  • Collaborates with all disciplines within the health plan to meet goals and objectives Assess and refers potential case management cases
  • Screens, identifies, and refers potential members to our organization’s case management and resource coordination
  • Ongoing assessment for quality indicators and concerns
  • Identifies potential quality of care issues, tracks into electronic system, and refers to appropriate
  • QM staff Assess and process all denial determination after medical director review
  • Ensures the timeliness of all denial letters within the regulations mandated


Qualifications:

  • Master’s degree in Speech-Language Pathology
  • Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association (ASHA) or Audiology Board Certification (ABC)
  • Licensure by The State Board of Examiners for Speech-Language Pathology and Audiology
  • Two years of professional speech-language pathology and/or utilization management experience


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