Director of Utilization Review

Signet Health Corporation; Midland (TX); On-site; USD 120,000 - 160,000; Full time

Job summary

Signet Health Corporation in Midland, TX seeks a Director of Utilization Review to lead the new Permian Basin Behavioral Health Center's utilization program, ensuring medical necessity and payer compliance across inpatient and outpatient services.

The role oversees admission reviews, denials management, and regulatory compliance, collaborating with clinicians and revenue cycle teams to optimize patient care and reimbursement.

Qualifications

• Current, unencumbered RN license in Texas (will also accept advanced behavioral health licenses like LCSW or LPC depending on scope).
• Minimum of 2 years of psychiatric or behavioral health clinical nursing experience.
• 2+ years of utilization review, case management, or managed care experience (Texas Medicare/Medicaid preferred).
• Proficiency with evidence-based criteria sets such as InterQual, MCG and EMR systems.

Responsibilities

• Utilization Management: conduct and oversee admission, continued-stay, and discharge reviews using InterQual or MCG.
• Insurance & payer relations: manage pre-certifications, concurrent reviews, and peer-to-peer escalations with insurers and Texas Medicaid managed care.
• Denial management: intervene early on potential denials, lead appeal processes, coordinate with revenue cycle teams.
• Regulatory compliance: adhere to Texas HHS regulations, DNV/ISO standards, and CMS conditions of participation.
• Interdisciplinary collaboration: work with psychiatrists, nursing staff, and social services during treatment team meetings.
• Data tracking: monitor LOS, denial rates, approval trends, and payer mix.

Skills

TX RN license

UR/Managed care experience

InterQual/MCG knowledge

EMR proficiency

Tools

EMR systems

Job description

Overview

Director of Utilization Review - Permian Basin Behavioral Health Center

Signet Health is currently recruiting for a Director of Utilization Review for a New, free-standing psychiatric hospital located at Permian Basin Behavioral Health Center in Midland, TX.

The Director of Utilization Review is responsible for managing operations to ensure that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer requirements, Texas Behavioral Health regulations, and DNV accreditation standards.

This is an onsite position. The schedule is Monday - Friday from 8:00 AM - 5:00 PM.

Core Responsibilities

• Utilization Management: Conduct and oversee admission, continued-stay, and discharge reviews using clinical criteria (InterQual or MCG).
• Insurance & Payer Relations: Manage pre-certifications, concurrent reviews, and peer-to-peer escalations with commercial insurers, Medicare, and Texas Medicaid managed care.
• Denial Management: Intervene early on potential denials, lead appeal processes, and coordinate with revenue cycle teams.
• Regulatory Compliance: Maintain adherence to Texas Health and Human Services (HHS) regulations, DNV/ISO standards, and CMS conditions of participation.
• Interdisciplinary Collaboration: Work alongside psychiatrists, nursing staff, and social services during daily treatment team meetings to support patient progression and efficient discharge planning.
• Data Tracking: Monitor key metrics including length of stay (LOS), denial rates, approval trends, and payer mix.

Requirements/Qualifications

• Licensure: Current, unencumbered Registered Nurse (RN) license in the State of Texas (will also accept advanced behavioral health licenses like LCSW or LPC depending on scope).
• Clinical Experience: Minimum of 2 years of psychiatric or behavioral health clinical nursing experience.
• UR/Managed Care Background: 2+ years of specific experience in utilization review, case management, or managed care environments (ideally involving Texas Medicare/Medicaid).
• Technical Knowledge: Proficiency with evidence-based criteria sets such as InterQual, MCG and electronic medical record (EMR) systems.
• Skills: Strong negotiation, critical thinking, regulatory compliance tracking, and professional communication abilities.

Hospital/Program Description

Living inMidland, Texasadds to the appeal, offering a high quality of life with affordable housing, short commutes, excellent schools, and a welcoming community. Midland blends small-city convenience with big-opportunity energy, featuring a vibrant arts scene, outdoor recreation, and easy access to regional travel-making it an ideal place to grow both professionally and personally.

Working at Permian Basin Behavioral Health Center offers the rare opportunity to be part of a brand-new, mission-driven organization that is transforming access to behavioral health care across West Texas and Southeast New Mexico. Team members play a meaningful role in building programs, shaping culture, and directly impacting lives in a growing region with a strong sense of purpose and collaboration.

Transforming Lives. Restoring Hope.

Permian Basin Behavioral Health Center (PBBHC) is a new, comprehensive mental health center serving the Permian Basin region of West Texas and Southeast New Mexico. Conveniently located between Midland and Odessa, PBBHC will offer both inpatient and outpatient behavioral health services for individuals of all ages.