Utilization Management Manager - RN

Texas Behavioral Health Center

The Texas Behavioral Health Center is a newly completed state-funded psychiatric hospital opening in Dallas’ Southwestern Medical District that is owned by the Texas Health and Human Services Commission (HHSC) and operated by UT Southwestern Medical Center.

When fully operational, the 505,000-square-foot facility will house 292 beds – 200 for adult patients and 92 for children and adolescents. As DFW’s first state-funded behavioral health hospital, it is designed to deliver state-of-the-art, patient-centered care in a modern and healing environment. The center provides comprehensive behavioral health treatment and features private patient rooms, abundant access to natural light and nature, and thoughtfully designed spaces that promote recovery. The hospital will also provide training to all behavioral health disciplines.

As employees of UT Southwestern, team members will join a world-class academic medical center committed to patient-centered care, innovation, interdisciplinary collaboration, and preparing patients for successful reintegration into their families and communities. With competitive benefits and a mission-driven culture, Texas Behavioral Health Center offers an unparalleled opportunity to make a lasting impact on mental health care in North Texas. Learn more about Texas Behavioral Health Center here!

WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the No. 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you’ll discover a culture of teamwork, professionalism, and a rewarding career! 

JOB SUMMARY
The RN Manager, Behavioral Health Utilization Management works under minimal supervision to provide leadership guidance to the Behavioral Health Utilization Management team by planning, organizing and supervising the activities of the staff. Develops policies and procedures for adherence to governmental and accrediting agency standards governing admissions, treatment and continued stay of behavioral health patients, including psychiatric and substance use disorder levels of care. 

 

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include\:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available 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
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION

Required

• Experience
  5 years in a healthcare management or utilization management position and 
  6 years nursing experience with three (3) years UM experience and 
  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 and 
  1 year of experience implementing utilization management policies, procedures and protocols for mental health services, either as a provider or manager and 
  1 year of experience supervising mental health providers or behavioral health utilization management staff and 
  Proven record of identifying process improvement opportunities and 
  Requires strong negotiating, analytical and organizational skills as well as the ability to be flexible with changing needs and deadlines; the ability to interact and communicate both verbally and in writing with all levels of associates, management and patients 
   

• Licenses and Certifications
  (RN) REGISTERED NURSE Current Texas Registered Nurse license is required. 
   

Preferred

• Education
  Bachelor's Degree BA/BS degree 
   

• Experience
  Acute inpatient behavioral health experience is strongly preferred 
  Knowledge of the healthcare revenue cycle, including insurance processes 
   

JOB DUTIES

• Ensures that behavioral health inpatient concurrent reviews and retrospective review requests are performed using nationally recognized and evidence based standards, including applicable psychiatric and substance use disorder criteria. Ensures quality of documentation and actively participates in managing behavioral health utilization across the Continuum of Care to full efficiency.
• Provides leadership guidance to the UM team. Tracks and monitors accuracy and timeliness of data entered by staff.
• Provides leadership in Health Services programs, operations, projects, policies and procedures to ensure high quality results. Leads team in assuring resources are optimally used to facilitate patient care goals, appropriate cost and length of stay.
• Consults with psychiatric providers, medical staff, UM team, Care Coordinators and social work as necessary to resolve immediate progression-of-care barriers through appropriate administrative and medical channels.
• Utilizes data research to develop and implement programs to reduce length of stay and address behavioral health discharge barriers. Interfaces with and coordinates efforts of admissions, Revenue Cycle and HIM/Coding/CDI relevant to concurrent utilization review system. Evaluates, recommends and implements policies and procedures related to utilization review system, including appropriate resource utilization and identification of avoidable days.
• Analyzes behavioral health authorization and denials information to identify problems and trends and develop reports/feedback to be presented to staff and Senior Management.
• Represents behavioral health utilization management at various committees, professional organizations and physician groups as needed.
• Serves as a resource person to physicians, Care Coordinators and billing office for coverage and compliance issues regarding utilization management.
• Leads quarterly meetings with the Utilization Review Committee and supports review of behavioral health utilization trends as applicable.
• Develops, implements and monitors utilization management policies, procedures and protocols for behavioral health and mental health services, including review of resource utilization data and trends to identify opportunities for real-time coaching and improved outcomes.
• Maintains behavioral health utilization management records, files, documents, reports and correspondence to support department operations, regulatory compliance and leadership reporting.

Knowledge, Skills and Abilities

• Supervise and subordinate staff.
• Effectively evaluate the medical records of hospital admissions regarding continuing stay necessity, appropriateness of setting, delivered care, use of ancillary services and discharge plans.
• Communicate documentation needs in an effective and tactful manner that promotes cooperation.
• Teach providers what is needed and required in the medical record for reimbursement and audit purposes.
• Apply 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 as demonstrated through education, training or work experience.
• Gather and analyze data and prepare reports and recommendations.
• Work effectively with physicians, health care team and outside payer sources.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Physical Requirements

• Carrying
• Lifting
• Standing
• Talking
• Walking

Working Conditions

• Clinical Setting
• Hospital Setting
• Office Setting

Salary Information
Salary is commensurate with education, skills, and relevant experience.

SECURITY AND EEO STATEMENT

Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.
 

Texas Behavioral Health Center

The Texas Behavioral Health Center is a newly completed state-funded psychiatric hospital opening in Dallas’ Southwestern Medical District that is owned by the Texas Health and Human Services Commission (HHSC) and operated by UT Southwestern Medical Center.

When fully operational, the 505,000-square-foot facility will house 292 beds – 200 for adult patients and 92 for children and adolescents. As DFW’s first state-funded behavioral health hospital, it is designed to deliver state-of-the-art, patient-centered care in a modern and healing environment. The center provides comprehensive behavioral health treatment and features private patient rooms, abundant access to natural light and nature, and thoughtfully designed spaces that promote recovery. The hospital will also provide training to all behavioral health disciplines.

As employees of UT Southwestern, team members will join a world-class academic medical center committed to patient-centered care, innovation, interdisciplinary collaboration, and preparing patients for successful reintegration into their families and communities. With competitive benefits and a mission-driven culture, Texas Behavioral Health Center offers an unparalleled opportunity to make a lasting impact on mental health care in North Texas. Learn more about Texas Behavioral Health Center here!

WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the No. 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you’ll discover a culture of teamwork, professionalism, and a rewarding career! 

JOB SUMMARY
The RN Manager, Behavioral Health Utilization Management works under minimal supervision to provide leadership guidance to the Behavioral Health Utilization Management team by planning, organizing and supervising the activities of the staff. Develops policies and procedures for adherence to governmental and accrediting agency standards governing admissions, treatment and continued stay of behavioral health patients, including psychiatric and substance use disorder levels of care. 

 

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include\:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available 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
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION

Required

• Experience
  5 years in a healthcare management or utilization management position and 
  6 years nursing experience with three (3) years UM experience and 
  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 and 
  1 year of experience implementing utilization management policies, procedures and protocols for mental health services, either as a provider or manager and 
  1 year of experience supervising mental health providers or behavioral health utilization management staff and 
  Proven record of identifying process improvement opportunities and 
  Requires strong negotiating, analytical and organizational skills as well as the ability to be flexible with changing needs and deadlines; the ability to interact and communicate both verbally and in writing with all levels of associates, management and patients 
   

• Licenses and Certifications
  (RN) REGISTERED NURSE Current Texas Registered Nurse license is required. 
   

Preferred

• Education
  Bachelor's Degree BA/BS degree 
   

• Experience
  Acute inpatient behavioral health experience is strongly preferred 
  Knowledge of the healthcare revenue cycle, including insurance processes 
   

JOB DUTIES

• Ensures that behavioral health inpatient concurrent reviews and retrospective review requests are performed using nationally recognized and evidence based standards, including applicable psychiatric and substance use disorder criteria. Ensures quality of documentation and actively participates in managing behavioral health utilization across the Continuum of Care to full efficiency.
• Provides leadership guidance to the UM team. Tracks and monitors accuracy and timeliness of data entered by staff.
• Provides leadership in Health Services programs, operations, projects, policies and procedures to ensure high quality results. Leads team in assuring resources are optimally used to facilitate patient care goals, appropriate cost and length of stay.
• Consults with psychiatric providers, medical staff, UM team, Care Coordinators and social work as necessary to resolve immediate progression-of-care barriers through appropriate administrative and medical channels.
• Utilizes data research to develop and implement programs to reduce length of stay and address behavioral health discharge barriers. Interfaces with and coordinates efforts of admissions, Revenue Cycle and HIM/Coding/CDI relevant to concurrent utilization review system. Evaluates, recommends and implements policies and procedures related to utilization review system, including appropriate resource utilization and identification of avoidable days.
• Analyzes behavioral health authorization and denials information to identify problems and trends and develop reports/feedback to be presented to staff and Senior Management.
• Represents behavioral health utilization management at various committees, professional organizations and physician groups as needed.
• Serves as a resource person to physicians, Care Coordinators and billing office for coverage and compliance issues regarding utilization management.
• Leads quarterly meetings with the Utilization Review Committee and supports review of behavioral health utilization trends as applicable.
• Develops, implements and monitors utilization management policies, procedures and protocols for behavioral health and mental health services, including review of resource utilization data and trends to identify opportunities for real-time coaching and improved outcomes.
• Maintains behavioral health utilization management records, files, documents, reports and correspondence to support department operations, regulatory compliance and leadership reporting.

Knowledge, Skills and Abilities

• Supervise and subordinate staff.
• Effectively evaluate the medical records of hospital admissions regarding continuing stay necessity, appropriateness of setting, delivered care, use of ancillary services and discharge plans.
• Communicate documentation needs in an effective and tactful manner that promotes cooperation.
• Teach providers what is needed and required in the medical record for reimbursement and audit purposes.
• Apply 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 as demonstrated through education, training or work experience.
• Gather and analyze data and prepare reports and recommendations.
• Work effectively with physicians, health care team and outside payer sources.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Physical Requirements

• Carrying
• Lifting
• Standing
• Talking
• Walking

Working Conditions

• Clinical Setting
• Hospital Setting
• Office Setting

Salary Information
Salary is commensurate with education, skills, and relevant experience.

SECURITY AND EEO STATEMENT

Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.