Director of Utilization Review

Signet Health; Midland (TX); On-site; USD 120,000 - 170,000; Full time

Job summary

Signet Health's Permian Basin Behavioral Health Center in Midland, TX is seeking a Director of Utilization Review to lead the on-site UR program for a brand-new psychiatric hospital.

The role includes directing admission and discharge reviews, managing pre-certifications and payer relations, ensuring CMS/DNV compliance, and coordinating with psychiatrists and nursing staff to optimize patient flow and care quality.

Qualifications

• Must hold an active Texas RN license (or equivalent advanced behavioral health license).
• Minimum 2 years in psychiatric/behavioral health nursing.
• 2+ years in utilization review, case management, or managed care.
• Experience with InterQual or MCG criteria and EMR systems.

Responsibilities

• Oversee admission, continued-stay, and discharge reviews using clinical criteria.
• Manage pre-certifications and payer relations with insurers and Medicaid managed care.
• Lead denial management, appeals, and revenue cycle coordination.
• Ensure compliance with Texas HHSC regulations, DNV/ISO, and CMS.
• Collaborate with psychiatrists, nursing, and social services for discharge planning.
• Track LOS, denial rates, approval trends, and payer mix.

Skills

InterQual/MCG criteria knowledge

Regulatory compliance tracking

Negotiation

Professional communication

Education

Registered Nurse (RN) license in Texas

Advanced behavioral health license (LCSW or LPC) depending on scope

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.