Manager - Utilization Management

North Texas Behavioral Health Authority; Dallas (TX); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

457(b) retirement plan

Paid time off

Health, dental, and vision insurance

Health savings account

Flexible spending account

Tuition reimbursement

Job summary

North Texas Behavioral Health Authority seeks an experienced Manager of Utilization Management in Dallas to oversee clinical reviews, determine funding eligibility, and ensure regulatory compliance. The role requires LPHA licensure in Texas, 3+ years of direct mental health care, and experience leading UM policies.

Travel 20–100% across Dallas, Ellis, Hunt, Kaufman, Navarro, and Rockwall counties; proficiency with MS Office and CMBHS is expected.

Qualifications

• Licensed Practitioner of the Healing Arts (LPHA) in Texas.
• 3+ years of direct care experience with persons with serious mental illness.
• 1+ year of experience implementing utilization management policies for mental health services; prior supervision experience.

Responsibilities

• Work autonomously and make clinical decisions per applicable rules and NTBHA procedures.
• Create, analyze, maintain records, reports and correspondence.
• Grant authorizations and conduct utilization reviews for behavioral health services.
• Review UA and SUD SARs in CMBHS and monitor adherence to contracts.
• Promote collaboration between Quality Management and Utilization Management.
• Utilize advanced Microsoft Office Suite and company programs.

Skills

Clinical decision making

Regulatory compliance

Data entry

Education

4 Year Degree

Tools

Microsoft Office

Job description

Position Details

Job Title: Manager – Utilization Management

Location: Dallas, TX 75251

Level: Experienced

Position Type: Full Time

Education Level: 4 Year Degree

Travel: 20%–100% of days, covering Dallas, Ellis, Hunt, Kaufman, Navarro, and Rockwall counties; fleet or personal vehicle may be required.

Overview

North Texas Behavioral Health Authority (NTBHA) develops a collaborative system of care for children, adolescents, and adults with severe mental illness, serious emotional disturbances, and substance use disorder. The Utilization Management Department ensures timely, medically necessary behavioral health services through utilization review, authorization management, funding determinations, and regulatory compliance. The UM Manager conducts clinical utilization reviews, determines funding eligibility and medical necessity, authorizes services, and ensures compliance with HHSC requirements, TAC, TRR standards, and NTBHA policies.

Responsibilities

• Work autonomously and make clinical decisions consistent with applicable rules, regulations, policies, and procedures.
• Create, analyze, prepare, and maintain records, files, documents, reports, and correspondence.
• Recognize problems, identify solutions, and facilitate them using knowledge of community resources and coordination principles.
• Communicate effectively with diverse populations through oral and written communication.
• Grant authorizations and conduct utilization reviews for behavioral health services based on clinical information and internal medical‑necessity criteria.
• Perform data entry, maintain files and reports, and complete routine office work.
• Review and approve Uniform Assessments (UA) and SUD SARs in CMBHS.
• Administer legal documentation for SPA bed letters and provide recommendations regarding Orders of Protective Custody (OPC).
• Monitor compliance with contracts entered into by NTBHA, including those with the State of Texas.
• Participate in departmental meetings, trainings, provider education, and special projects, promoting collaboration between Quality Management and Utilization Management functions.
• Use advanced Microsoft Office Suite skills (Outlook, Word, Excel, PowerPoint) and become familiar with company‑specific programs.
• Adapt to changing duties and projects as required by business needs.
• Classify as exempt; require scheduling flexibility to meet organizational needs.

Qualifications

• Licensed Practitioner of the Healing Arts (LPHA) in Texas (RN, RN‑APN, PA, LPC, LCSW, or LMFT).
• At least three (3) years of direct care experience with persons with serious mental illness and documented training in psychopharmacologic management.
• At least one (1) year of experience implementing utilization management policies, procedures, and protocols for mental health services, either as a provider or manager; at least one year supervising providers.
• Familiarity with behavioral health systems of care, TRR program rules, regulations, and guidelines, and knowledge of the Texas Administrative Code (TAC) preferred.
• Valid Texas driver’s license.

Travel

Travel may be required as part of this role’s duties and can vary from 20% to 100% per day. Trips will cover all counties within the NTBHA catchment area (Dallas, Ellis, Hunt, Kaufman, Navarro & Rockwall). The position may require using a fleet vehicle and/or a personal vehicle for business needs, including field and home visits, off‑site meetings, co‑located sites, and pickup items. Transportation of individuals is allowed only with a company vehicle and management approval.

Benefits

• 457(b) retirement plan
• Paid time off
• Health, dental, and vision insurance
• Health savings account
• Flexible spending account
• Tuition reimbursement