Utilization Management Director
: Job Details :

Job Title: Utilization Management Director

Position's Role Summary:

North Texas Behavioral Health Authority (NTBHA), based in Dallas is responsible for developing a collaborative system of care for children, adolescents and adults with severe mental illness and other serious emotional disturbances, as well as those experiencing a substance use disorder within a six-county area. This position's actions and work must align with NTBHA values and goals, regulations, and policies and procedures, and meet all documentation standards and regulatory requirements.

Summary of Essential Duties and Responsibilities:

• Primary functions are managing the UM team. Oversite of granting authorizations and conducting utilization reviews for behavioral health services per clinical information given by providers and internal criteria for medical necessity and appropriateness of care.
• Will monitor compliance with and for various contracts entered by NTBHA, including with the State of Texas and local entities.
• Specific duties: assist in daily authorizations of inpatient private psychiatric bed (PPB)funding-assist in data entry and tracking, maintain UM staff schedule to ensure coverage, assist in clinical staffing with UM staff.
• Data entry, maintaining files and reports, and performing other routine office work are required in this position.
• This position will require excellent communication, organizational and documentation skills as well as the ability to use multiple computer software applications, including Web CARE and CMBHS.
• Work is achieved under minimal supervision with considerable latitude for the use of initiative and independent judgment.
• Excellent communication and documentation skills as well as the ability to use multiple computer software applications.
• Duties and projects may be assigned or changed to meet business needs.
• Chairs the NTBHA Quarterly QM/UM Committee
• Completes the UM Program Self-Assessment required by HHSC.
• Attends all local and statewide meetings/workgroups as requested by supervisor.
• Provides community development trainings as needed.

Required Skills and Abilities:

• Work autonomously and to make decisions consistent with applicable rules, regulations, policies and procedures.
• Create, analyze, prepare, and maintain records, files, documents, reports, and correspondence.
• Recognize problems and identify and facilitate solutions. Knowledge of community resources, local indigent behavioral health systems and local authority/service coordination principles, objectives, standards, and methods, and of program policies and procedures.
• Communicate effectively and use effective interpersonal skills to communicate ideas and complex concepts with individuals from diverse cultural and socio-economic backgrounds through oral and written communication.
• Constructively and efficiently work with other professionals and staff, community representatives, persons with disabilities, and family members.
• Foster strong, positive, and effective working relationships with inter-agency and intra-agency team members, encouraging and supporting interaction among various team members across organizational lines.
• Must be able to work on and have knowledge of computers and programs such as: Advanced Microsoft Office Suite skills - Outlook, Word, Excel, PowerPoint, etc., with an ability to become familiar with company-specific programs and software.

Education, Training and Experience (including licensure and certification)

• Licensed Practitioner of the Healing Arts (LPHA) in the state of Texas, RN, RN-APN, PA, LPC, LCSW or LMFT.
• At least five years' experience in direct care of persons with a serious mental illness, documented training in psychopharmacologic management of serious mental illness, and medical/psychiatric co-morbidity and complications in chronic serious mental illness.
• At least five years' experience participating as a member of a treatment team that develops and monitors treatment plans for persons with chronic & serious mental illness.
• At least one year's experience with the implementation of utilization management policies, procedures, and protocols for MH services, either as a provider or manager; at least one year's experience supervising MH providers.

We are responsible for developing a collaborative system of care for individuals in crisis in the NTBHA service area. We are focused on trauma-informed, resilience-oriented care in all services provided.

NTBHA is deeply committed to diversity, equity, and inclusion, both in our hiring practices and in our experiences as employees. We strive to create a mindful and respectful environment and culture that is free of perceived harassment, racism, and discrimination, creating an environment of understanding and compassion for all lived experiences.