Manager, Utilization Management (RN) - Texas Behavioral Health Center

UT Southwestern Medical Center • Dallas, TX

7d • Onsite

About The Position

The RN Manager, Behavioral Health Utilization Management works under minimal supervision to provide leadership and guidance to the Behavioral Health Utilization Management team by planning, organizing, and supervising staff activities. The manager develops and maintains policies and procedures that comply with governmental and accrediting agency standards for admissions, treatment, and continued stays of behavioral health patients, including psychiatric and substance use disorder levels of care.

The role ensures the quality and timeliness of behavioral health utilization reviews and documentation, supports efficient use of resources and appropriate patient length of stay, and works with providers, care coordinators, social work, admissions, Revenue Cycle, and HIM/Coding/CDI to address care progression barriers and utilization issues. The manager analyzes authorization, denial, and utilization data; develops improvement initiatives and reports; and represents behavioral health utilization management with committees, professional organizations, and physician groups.

Requirements

• Five years of experience in a healthcare management or utilization management position.
• Six years of nursing experience, including three years of utilization management experience.
• Experience in behavioral health utilization management, including psychiatric and/or substance use disorder levels of care, medical necessity review, payer authorization processes, and continued-stay review.
• One year of experience implementing utilization management policies, procedures, and protocols for mental health services, as a provider or manager.
• One year of experience supervising mental health providers or behavioral health utilization management staff.
• A proven record of identifying process-improvement opportunities.
• Strong negotiating, analytical, and organizational skills, with flexibility to respond to changing needs and deadlines.
• Ability to communicate verbally and in writing with associates, management, and patients at all levels.
• Current Texas Registered Nurse (RN) license.
• Ability to effectively evaluate medical records for medical necessity, setting appropriateness, delivered care, ancillary services, and discharge plans.
• Ability to communicate documentation needs effectively and tactfully and teach providers documentation requirements for reimbursement and audits.
• Knowledge of behavioral health medical necessity review, psychiatric levels of care, continued-stay criteria, payer authorization requirements, and discharge barriers.
• Ability to work with child, adolescent, and adult behavioral health populations, demonstrated through education, training, or work experience.
• Ability to work effectively with physicians, healthcare teams, and outside payer sources.

Nice To Haves

• Bachelor's degree (BA/BS).
• Acute inpatient behavioral health experience is strongly preferred.
• Knowledge of the healthcare revenue cycle, including insurance processes.

Responsibilities

• Ensure behavioral health inpatient concurrent reviews and retrospective review requests use nationally recognized, evidence-based standards, including applicable psychiatric and substance use disorder criteria.
• Ensure documentation quality and actively manage behavioral health utilization across the Continuum of Care for full efficiency.
• Provide leadership guidance to the Utilization Management team and monitor the accuracy and timeliness of staff data entry.
• Lead Health Services programs, operations, projects, policies, and procedures to support high-quality results and optimal resource use, appropriate cost, and length of stay.
• Consult with psychiatric providers, medical staff, the UM team, Care Coordinators, and social work to resolve immediate progression-of-care barriers through appropriate administrative and medical channels.
• Use data research to develop and implement programs to reduce length of stay and address behavioral health discharge barriers.
• Coordinate with admissions, Revenue Cycle, and HIM/Coding/CDI regarding the concurrent utilization review system.
• Evaluate, recommend, and implement utilization review policies and procedures, including those concerning resource utilization and avoidable days.
• Analyze behavioral health authorization and denial information to identify problems and trends, and develop reports and feedback for staff and Senior Management.
• Represent behavioral health utilization management at committees, professional organizations, and physician groups as needed.
• Serve as a resource to physicians, Care Coordinators, and the billing office on coverage and compliance issues related to utilization management.
• Lead quarterly Utilization Review Committee meetings and support review of behavioral health utilization trends.
• Develop, implement, and monitor utilization management policies, procedures, and protocols for behavioral health and mental health services; review resource utilization data and trends to identify opportunities for real-time coaching and improved outcomes.
• Maintain behavioral health utilization management records, files, documents, reports, and correspondence for department operations, regulatory compliance, and leadership reporting.
• Supervise subordinate staff.
• Evaluate hospital admission medical records for continuing-stay necessity, appropriateness of setting, delivered care, use of ancillary services, and discharge plans.
• Communicate documentation requirements tactfully and effectively, teach providers what medical records must contain for reimbursement and audit purposes, and work effectively with physicians, healthcare teams, and outside payer sources.
• Gather and analyze data and prepare reports and recommendations.

Benefits

• PPO medical plan available on day one at no cost for full-time employee-only coverage.
• 100% coverage for preventive healthcare with no copay.
• Paid Time Off available on day one.
• Retirement programs through the Teacher Retirement System of Texas (TRS).
• Paid parental leave benefit.
• Wellness programs.
• Tuition reimbursement.
• Public Service Loan Forgiveness (PSLF) qualified employer.
• Competitive and comprehensive benefits package for eligible employees.

What This Job Offers

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