Strategic Utilization Review Director - Behavioral Health

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

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.