The mission of Correctional Managed Care is to address the healthcare needs of underserved patient populations within the Texas Department of Criminal Justice (TDCJ) and the Texas Juvenile Justice Department (TJJD).

JOB SUMMARY:Monitors and communicates each individual plan of care with patients, families, referring physicians, and UTMB staff. Ensuring the utmost quality in patient care, efficiency, cost effectiveness, and compliance within certain programs/UTMB policies and procedures, as well as guidelines set by MQSA, FDA, ACR, and the Texas Medical Board.

ESSENTIAL JOB FUNCTIONS:

• Maintains proper documentation on the Radiology Information System, EPIC and Breast Imaging Database for procedure tracking.
• Communicates and consults with patients informing them of procedures to be performed to ensure that patients are as comfortable as possible.
• Conducts comprehensive assessment of patient in person, by telephone or by review of medical records. Gathers information from patient records and consults clinical team as needed. Determines financial and medical status by reviewing patient’s diagnosis, recommended treatment, funding sources and special needs according to UTMB policies and procedures.
• Refers patients to identified primary care providers as needed. Oversees implementation of plan of care, schedules appointments and provides relevant clinical information to primary care/referring provider and/or specialty provider to ensure quality and continuity of patient care. Completes relevant documentation, intervening to optimize use of resources for cost effective healthcare.
• Reviews referrals to primary/specialty clinics for appropriateness based on established clinic criteria. Reviews all available clinical data to ensure appropriate decision making. May facilitate required clinical and diagnostic work up to ensure that all is completed prior to approving the patient for a specialty appointment. Refers unfunded patients for financial counseling. Determines priority of appointment scheduling, contacting providers and others as needed for overbook approval.
• Serves as a patient advocate, focusing on patients’ needs, rights, confidentiality and cultural preferences. Serves as a resource person for specific clinical and patient care issues, helping to negotiate desirable patient outcomes. Serves as a liaison between provider and patient/family to facilitate communication and services.
• Promotes collaborative practice among patients, their families and multidisciplinary health care team members by attending meetings and acting as a consultative resource to physicians and UTMB staff. Maintains a positive relationship with all UTMB internal and external customers. Assists in scheduling procedures for assigned population based on medical necessity.
• Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements and monitors results as appropriate in support of the overall goals and mission of UTMB.Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the Breast Imaging area. Develops effective internal controls that promote adherence to applicable state/federal laws, and the program requirements of accreditation agencies and federal, state, and private health plans. Seeks advice and guidance as necessary to ensure proper understanding.
• Stays abreast of the latest developments, advancements, and trends in the field of Breast Imaging by attending seminars, reading professional journals and maintaining Patient Navigating certification.
• Participates in departmental Performance Improvement Programs. Attends department and modality meetings satisfactorily.
• Adheres to internal controls and reporting structure established for department.
• Performs other related duties as required. 

KNOWLEDGE/SKILLS/ABILITIES:

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills and competency assessments.
• Possesses advanced computer knowledge; operates multiple computer systems to include, Hospital Information Systems, Office software, post processing/reporting systems to maintain patient and exam documents.
• Exhibits strong interpersonal and team player skills with all levels of the healthcare team and assures delivery of excellent customer service to all patients, visitors, physicians and co-workers.
• Adapts to multiple ongoing priorities with minimal supervision including, organizing workflow and actively participating in problem-solving.
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles.
• Demonstrates basic knowledge of Breast Imaging.

EQUIPMENT:

• Standard equipment used for Imaging.

WORK ENVIRONMENT:

• Standard hospital, clinical, laboratory and/or office environment.
• Includes office, patient care units, and invasive procedure areas.
• Extended periods of sitting, standing and/or walking.
• Able to flex hours, work other shifts, and/or rotate facilities to meet needs related to unanticipated acuity; meet operational needs.

May be required to work within the confines of a prison, jail, or juvenile detention center.