Director of Utilization Review

Signet Health Corporation • Midland, TX

1d • Onsite

About The Position

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.

Requirements

• 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).
• Minimum of 2 years of psychiatric or behavioral health clinical nursing experience.
• 2+ years of specific experience in utilization review, case management, or managed care environments (ideally involving Texas Medicare/Medicaid).
• Proficiency with evidence-based criteria sets such as InterQual, MCG and electronic medical record (EMR) systems.
• Strong negotiation, critical thinking, regulatory compliance tracking, and professional communication abilities.

Responsibilities

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

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed