Director of Utilization Review

Posted 2 Days Ago
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Midland, TX, USA
In-Office
Junior
Healthtech
The Role
Directs utilization review operations for a psychiatric hospital, overseeing admissions, continued-stay and discharge reviews, payer authorizations, denial appeals, regulatory compliance, and utilization metrics. Collaborates with psychiatrists, nursing, and social services to support medical necessity, patient progression, and efficient discharge planning. Requires Texas RN licensure or qualifying behavioral health license, psychiatric clinical experience, utilization review or managed care experience, and proficiency with InterQual, MCG, and EMR systems.
Summary Generated by Built In
Overview

Director of Utilization Review - Permian Basin Behavioral Health Center

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.

This is an onsite position. The schedule is Monday – Friday from 8:00 AM – 5:00 PM.

Core Responsibilities

  • Utilization Management: Conduct and oversee admission, continued-stay, and discharge reviews using clinical criteria (InterQual or MCG).
  • Insurance & Payer Relations: Manage pre-certifications, concurrent reviews, and peer-to-peer escalations with commercial insurers, Medicare, and Texas Medicaid managed care.
  • Denial Management: Intervene early on potential denials, lead appeal processes, and coordinate with revenue cycle teams.
  • Regulatory Compliance: Maintain adherence to Texas Health and Human Services (HHS) regulations, DNV/ISO standards, and CMS conditions of participation.
  • Interdisciplinary Collaboration: Work alongside psychiatrists, nursing staff, and social services during daily treatment team meetings to support patient progression and efficient discharge planning.
  • Data Tracking: Monitor key metrics including length of stay (LOS), denial rates, approval trends, and payer mix.
Requirements/Qualifications
  • Licensure: 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).
  • Clinical Experience: Minimum of 2 years of psychiatric or behavioral health clinical nursing experience.
  • UR/Managed Care Background: 2+ years of specific experience in utilization review, case management, or managed care environments (ideally involving Texas Medicare/Medicaid).
  • Technical Knowledge: Proficiency with evidence-based criteria sets such as InterQual, MCG and electronic medical record (EMR) systems.
  • Skills: Strong negotiation, critical thinking, regulatory compliance tracking, and professional communication abilities.
Hospital/Program Description

Living in Midland, Texas adds to the appeal, offering a high quality of life with affordable housing, short commutes, excellent schools, and a welcoming community. Midland blends small-city convenience with big-opportunity energy, featuring a vibrant arts scene, outdoor recreation, and easy access to regional travel—making it an ideal place to grow both professionally and personally.


Working at Permian Basin Behavioral Health Center offers the rare opportunity to be part of a brand-new, mission-driven organization that is transforming access to behavioral health care across West Texas and Southeastern New Mexico. Team members play a meaningful role in building programs, shaping culture, and directly impacting lives in a growing region with a strong sense of purpose and collaboration.


Transforming Lives. Restoring Hope.


Permian Basin Behavioral Health Center (PBBHC) is a new, comprehensive mental health center serving the Permian Basin region of West Texas and Southeastern New Mexico. Conveniently located between Midland and Odessa, PBBHC will offer both inpatient and outpatient behavioral health services for individuals of all ages.


Skills Required

  • Current, unencumbered Registered Nurse license in Texas, or an advanced behavioral health license such as LCSW or LPC within applicable scope
  • Minimum of 2 years of psychiatric or behavioral health clinical nursing experience
  • At least 2 years of utilization review, case management, or managed care experience
  • Experience involving Texas Medicare or Medicaid managed care
  • Proficiency with InterQual or MCG evidence-based criteria
  • Proficiency with electronic medical record systems
  • Strong negotiation, critical thinking, regulatory compliance tracking, and professional communication skills
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The Company
750 Employees
Year Founded: 1999

What We Do

Signet Health is a national healthcare company that partners with hospitals across the United States to build and manage behavioral-health, psychiatric, addiction-recovery, and acute physical-rehabilitation programs. Its clinical and operations teams help hospitals expand access, improve care delivery, and operate sustainable services tailored to local patient needs. The company also provides contract management for physical medicine and rehabilitation programs for hospital clients nationwide.

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