Utilization Review Director – Behavioral Health

Signet Health; Midland (TX); On-site; USD 120,000 - 180,000; Full time

Job summary

Signet Health seeks a Director of Utilization Review for the Permian Basin Behavioral Health Center, a new free-standing psychiatric hospital in Midland, TX. This onsite role oversees admission, discharge reviews and payer relations to ensure medical necessity and compliance with regulations.

The position requires RN (TX) licensure with psychiatric experience, at least 2 years in utilization review or managed care, and proficiency with InterQual/MCG.

Qualifications

• RN license in Texas (required) or advanced behavioral health license depending on scope.
• Minimum of 2 years of psychiatric/behavioral health clinical nursing experience.
• 2+ years of utilization review, case management, or managed care experience (ideally Texas Medicare/Medicaid).
• Proficiency with InterQual, MCG and EMR systems.
• Strong negotiation, regulatory compliance tracking, and professional communication abilities.

Responsibilities

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

Skills

Negotiation

Critical thinking

Regulatory compliance tracking

Professional communication

Education

Registered Nurse (RN) license in Texas

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

Tools

InterQual

MCG

EMR systems

Job description

Signet Health seeks a Director of Utilization Review for the Permian Basin Behavioral Health Center, a new free-standing psychiatric hospital in Midland, TX. This onsite role oversees admission, discharge reviews and payer relations to ensure medical necessity and compliance with regulations.

The position requires RN (TX) licensure with psychiatric experience, at least 2 years in utilization review or managed care, and proficiency with InterQual/MCG.