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UTMB Health
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  • Senior Contract Administrator - Managed Care (Payer Contracting)  

    - Galveston County
    EDUCATION EXPERIENCE: Minimum Qualifications: Bachelor’s degree. Seven... Read More
    EDUCATION EXPERIENCE: Minimum Qualifications: Bachelor’s degree. Seven (7) years related experience. Three (3) or more years of experience negotiating managed care contracts with third party payors. Preferred Qualifications: Master’s degree in Business Administration (MBA) or Health Administration (MHA). Candidates with a Bachelor’s degree in a related field may also be considered if they possess substantial experience in managed care contracting and payer negotiations. Demonstrated experience in contract negotiation and strong knowledge of healthcare reimbursement methodologies is highly valued. JOB SUMMARY: The primary responsibility of the Managed Care, Senior Contract Administrator position is leading, developing, and negotiating managed care agreements to ensure favorable reimbursement, alignment with organizational goals, and compliance with federal and state regulations. This role will oversee payer relationships, evaluate financial and operational performance of contracts, and collaborate across departments to support strategic initiatives related to revenue cycle, provider relations, and population health management. ESSENTIAL JOB FUNCTIONS: Lead the development, negotiation, and management of contracts with commercial and government payers, including HMOs, PPOs, ACOs, and Medicaid/Medicare Advantage plans. Analyze reimbursement methodologies and contract performance to ensure profitability and operational effectiveness. Develop and maintain strong relationships with payer representatives to facilitate contract negotiations and dispute resolution. Collaborate with finance, legal, revenue cycle, and clinical operations to ensure contract terms align with organizational capabilities and compliance standards. Monitor regulatory and market changes affecting payer contracts, providing strategic insights and recommendations. Develop key performance indicators (KPIs) to evaluate contract outcomes and drive data informed decisions. Lead contract implementation efforts, including communication, education, and ongoing oversight. Represent the organization in payer meetings, contract review sessions, and industry forums. Provide leadership, mentorship, and guidance to Contract Administrators and related staff. Independently prepares and presents strategic, financial and operational proposals regarding payor agreements. Ensures contractual compliance with federal, state, and institutional requirements. Assists with strategic planning and business development. Marginal or Periodic Functions: Adheres to internal controls and reporting structure. Performs related duties as required. KNOWLEDGE/SKILLS/ABILITIES: Excellent written and verbal skills; negotiation skills, computer proficiency (Excel and various software programs, data report writers). Strong interpersonal and verbal and written communication skills. Strong analytical and quantitative skills for the development of reimbursement proposals. Strong knowledge of healthcare reimbursement models, contract terms, and regulatory compliance. Knowledgeable of professional and hospital physician service compensation models issues and experience with fee schedule, case rate, per diem, and capitation reimbursement. Exceptional negotiation, communication, and relationship management skills. Proficiency in data analysis, contract modeling, and financial forecasting. Knowledgeable of patient accounting tasks including billing, collections, and reimbursement analysis. Strategic thinker with the ability to influence cross-functional teams. Familiarity with tools such as Microsoft Excel, contract management software, and healthcare data systems (e.g., Epic, etc.). WORKING ENVIRONMENT/EQUIPMENT: Hybrid or on-site work options available, depending on organizational policy and at leader discretion. May require occasional travel to payer offices or industry meetings. Standard office equipment and computer programs., clinical, and/or office environments. SALARY RANGE: Actual salary commensurate with experience. WORK SCHEDULE: Hybrid position (approximately 20–40% on-site), Monday–Friday, 8:00 AM – 5:00 PM. Equal Employment Opportunity 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 Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities. Read Less
  • Nurse Clinician III (RN) - CT Surgery/Vascular Surgery (Nights)  

    - Galveston County
    REQUIRED EDUCATION EXPERIENCE: RN with two years of clinical RN experi... Read More
    REQUIRED EDUCATION EXPERIENCE: RN with two years of clinical RN experience. Must possess and maintain a current license or valid permit to practice in Texas. Current BLS required. REQUIRED LICENSES/CERTIFICATIONS: RN BLS JOB SUMMARY: Competent Clinician. Possesses knowledge and skill to meet standards for competent professional nursing practice as specified in the Texas Nurse Practice Act. Experienced, knowledgeable and skilled in specialty area. Competently functions as a member of the interdisciplinary team. Practice is characterized by predominantly interdependent decision-making. Practice is problem focused and patient centered in the manner care is provided. Able to manage unexpected or emergency situations that are commonly seen in assigned specialty population. Serves as a resource for Nurse Clinician I or II. Can manage commonly seen contingency situations that arise on the clinical unit. Provides patient care through nursing practices based upon the American Nurses Association Standards of Professional Practice, and Professional Performance. Values specialty unit, nursing, and institutional strategic initiatives and health system goals. ESSENTIAL JOB FUNCTIONS Professional Practice: Nursing Process Assesses, plans, implements, evaluates, and documents the daily care of assigned patients. Identifies nursing diagnoses/patient care needs. Develops and individualizes care plan and revises plan of care as needed. Executes physician's orders for all assigned patients. Administers medications and treatments and delivers culturally congruent and specialty appropriate competent nursing care in accordance with UTMB's policies, procedures, and standards in a caring and compassionate manner. Performs routine technical procedures/skills in specialty area assigned. Patient/Family Teaching Health Promotion Provides basic patient/family instruction and healthcare teaching based on identified learning needs (patient values, beliefs, barriers, and readiness to learn). Identifies potential impact of family dynamics*. Utilizes evidence-based resources to provide patient/family education. Uses Teach-Back to determine effectiveness and modifies strategies as needed. Care Coordination Delegation Plans, coordinates, and prioritizes patient care activities according to skill level and work complexity. Maintains safety and continuity of care using methods such as bedside shift report, hand-off tools/processes, inter-disciplinary rounding, etc. Demonstrates effective time management skills. Delegates appropriately, seeking guidance when needed. Demonstrates competent use of technology in the delivery of patient care. Professional Performance: Ethics (legal/regulatory), Advocacy Culturally Congruent Cares Identifies ethical situations and seeks assistance, if necessary, to resolve. Utilizes available resources when ethical issues arise. Delivers culturally sensitive care using resources to meet the needs of patient/family. Serves as a patient advocate, seeking guidance when necessary. Communication Collaboration Supports healthy work environment by demonstrating respectful verbal and non-verbal communication with all members of the healthcare team. Seeks assistance for support with challenging communication. Recognizes colleagues when they go above and beyond in demonstrating UTMB’s core values. Plans, coordinates, and prioritizes patient care activities in collaboration with inter-professional team. Leadership Recognizes informal and formal unit/hospital leaders and can educate colleagues regarding unit/hospital leadership. Recognizes unit, nursing, and institutional strategic initiatives and health system goals. Recognizes the importance of financial responsibility to promote fiscal health for the patient, unit and organization. Education, Evidence-Based Practice Research Attends/participates in unit meetings/activities and supports the philosophy and goals of the unit department and organization. Participates in shared leadership at the unit level*. Participates in unit based quality improvement activities. Attends in-services and continuing education activities. Participates in one journal club annually*. Completes the UTMB/Vizient™ Nurse Residency Program and completes an evidence based practice project as required*. Demonstrates commitment to lifelong learning (evidence-based practice, specialty certification, advanced degree, etc.). Demonstrates ability to accept and adopt change by seeking knowledge and needed information. Demonstrates knowledge of how to access and utilize evidence-based resources to guide patient care. Quality, Resources Safety Identifies patient safety concerns and reports appropriately; addresses immediate safety concerns appropriately. Identifies unit quality metrics/outcomes data and improvement activities; actively engages in discussion, activities related to unit goals. Demonstrates self-care through practices that support personal well-being, personal safety and injury prevention. General Requirements: Completes required specialty specific Competency Based Orientation (CBO) tools by the initial performance evaluation due date for placement in employee file. Actively participates in ongoing self-evaluation of competency using Competency Based Orientation (CBO) tools and e-performance nursing appraisal. Completes the annual self-evaluation on time for competency and performance evaluation. Performs and reports point of care testing (POCT). Prioritizes and organizes work so that required assignments are completed within a specified time frame. Provides and maintains a clean, safe environment and performs and/or assists others to perform proper aseptic technique, isolation procedures and infection control measures. Practices basic cost containment for patients and the unit. Consistently completes accurate, concise and legible documentation for all patient, unit and hospital records (including care delivery and telephone patient related interactions). Competently utilizes electronic forms of communication and documentation. Meets periodic UTMB and unit specific compliance requirements for health screening, training, attendance, safety, and CPR. Adheres to internal controls and reporting structure. SALARY RANGE: Salary commensurate with experience. Equal Employment Opportunity 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 Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities. Read Less
  • Clerical 1 year of related experience. Preferred Qualifications: Exper... Read More
    Clerical 1 year of related experience. Preferred Qualifications: Experience or exposure to Epic, including billing, denials, coding and work queues. Understanding of healthcare revenue cycle process. Strong organization skills and attention to detail. OBGYN/Pedi Provider Enrollment process. CPT appeals. Managing the RWSP Grants and Contracts. Job Description: To provide coordination of all phases and activities associated with special university or community programs. Job Duties: The Coordinator I role will focus on streamlining billing processes, improving patient collections, and enhancing denial management and revenue recovery efforts for the Department of Obstetrics and Gynecology. Key Responsibilities: The Coordinator I will provide comprehensive administrative support to the Department of Obstetrics and Gynecology. Job duties include, but are not limited to, the following: Liaison: Coordinate with report writers to develop department-specific reporting on revenue and reimbursement trends and analyze reports on an ongoing basis. Meet with department stakeholders to review reporting and assist with root cause analysis, which may result in recommended workflow or system changes to improve performance. In conjunction with Revenue Cycle, Finance, and Health System/SOM leadership, assume responsibility for the adoption of reporting and metric targets by supported departments. Provide the data necessary to drive department accountability and achievement of metrics. Promote process standardization across related departments in order to improve revenue capture and reimbursement. Denial Management: Coordinate with report writers to develop department-specific reporting on denials and avoidable write-offs and analyzing reports on an ongoing basis. Prepare, compile, and distribute regular denial and AWO reports, and present data to appropriate stakeholders including the HB and PB Denial/AWO Committees. Meet with department stakeholders to review reporting and assist with root cause analysis, which may result in recommended workflow or system changes to improve performance. Provide trending on the types of claims denied and root causes of denials and collaborate with team members to make recommendations for improvement and issue resolution. Maintain an updated issues list on behalf of the HB and PB Denial/AWO Committees and follow up with owning areas as necessary to ensure progress and adherence to resolution plans. Coordinate with IS on completion of any build or enhancements to the system to resolve technical issues related to denial management. Salary Range: Actual salary commensurate with experience or range if discussed and approved by hiring authority. EQUAL EMPLOYMENT OPPORTUNITY: 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 Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities. Read Less
  • Certified Medication Aide - CMC - Estelle  

    - Walker County
    Certified Medication Aide - CMC - Estelle **Huntsville, Texas, United... Read More
    Certified Medication Aide - CMC - Estelle **Huntsville, Texas, United States** Allied Health UTMB Health Requisition # 2504140 The mission of Correctional Managed Care is to address the healthcare needs of underserved patient populations within the Texas Department of Criminal Justice and the Texas Juvenile Justice Department. **_JOB SUMMARY_** **:** Performs technical duties in the field of patient care and participates in the general health care of patients by providing assistance with cleanliness, grooming, rest, activity, nourishment, and distribution of medications. Assists the professional staff in maintaining a safe therapeutic environment. **_ESSENTIAL JOB FUNCTIONS_** **:** + Collects, reports and documents data: vital signs, height and weight, intake and output, pulse oximetry, and collects specimens. + Performs and reports Point of Care Testing. + Assists with patient activities and care as assigned by the charge nurse/designee as indicated by the patient's plan of care. + Provides for patients' personal hygiene: bathes patients, performs oral suctioning and superficial wound care, assists with chronic wound care, provides skin care for patient with TED hose, SCD, casts, skeletal pins, assists with elimination, cares for the incontinent patient, cares for the patient with a urinary catheter, assists or gives cleansing enemas, sitz baths, non-sterile douches, and provides ostomy care. + Assists with feeding. + Ambulates, positions, and turns patients and cares for the patient with altered mobility. + Assists with patient safety related to age and condition: assists with patient restraints, assists with patient specific safety precautions, collects, reports and documents data related to patient needs/emergencies and usual patient behavior, and cares for the patient in a correctional environment. + On incoming facilities, interviews incoming patients and completes receiving/screening form; informs nurses and/or physicians/advanced practice providers/mid level practitioners of patients with health problems who need immediate attention; records on newly received patients; maintains statistical logs required for periodic reports; performs all duties necessary for psychiatric referrals and screening. + Assists in the maintenance of a safe, comfortable facility environment; obtains, stores and maintains pharmacy and nursing medications/supplies. + Distributes and documents patients' medications, both in general population and administrative segregation, from filled prescriptions, abiding by Title 40, Texas Administrative Code, Chapter 95, "Licensing Standards for Medication Aides Handbook". + Ensures drug room security, replaces facility working drug stocks, and maintains the upkeep of facility drug room and pharmaceutical equipment. + Enters medication compliance into the pharmacy computer system. + Maintains patients' privacy and confidentiality of information and records at all times. + Practices basic cost containment and utilization management for patient care and facility operations. + Prioritizes and organizes work so that required assignments are completed within specified timeframe. + Promotes positive interpersonal relationships among co-workers and Security. + Participates in in-service orientation and continuing education classes. Obtains 40 hours of continuing education/in-service hours on an annual basis to meet ACA standards. + Adheres to internal controls and reporting structures established for department. + Performs related duties as required. **_EQUIPMENT_** **:** Standard patient care supplies, equipment and mechanical devices. **_WORK ENVIRONMENT_** **:** + Work environment is located in a clean and safe medical facility within the confines of a prison, jail or juvenile detention center. + Conditions such as noise, odors, cramped work space and/or fumes could sometimes cause discomfort. + Moderate to extreme physical effort may be required such as walking, standing, and lifting materials, equipment, objects, and/or patients. + Lifting may be heavy and awkward, over 50 lbs. + Vision, hearing, talking, and sense of touch abilities must be adequate enough to enable one to quickly and accurately perform tasks such as: reading small print, reading from monitoring equipment, defining details, sending and receiving clear and accurate verbal communication. + Frequent periods of concentrated or focused attention will be needed to interpret visual, auditory, and sensory inputs. + Shift work is required. + Alertness and careful attention to detail will bel required to avoid injury. + May be assigned to more than one facility. + May be exposed to such occupational hazards as communicable diseases, radiation, chemotherapeutic agents, and disoriented or combative patients. + May be required to be on standby and work extended or alternate shifts in situations deemed necessary by nurse manager. + Able to work under stress and be emotionally capable of coping with complex and/or changing activities. Security clearance is required; pre-employment drug testing is also required. **_REQUIRED EDUCATION/EXPERIENCE_** **:** + High school or GED equivalent. + Current Texas Certified Medication Aide permit. Salary is commensurate with years of relevant work experience. **Equal Employment Opportunity** _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 Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities._ Compensation Read Less

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