Utilization Manager Jobs in Prosper, TX (NOW HIRING)

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Job Title: Manager - Utilization Management 

Do you have a passion for helping others and want a career where you can make a difference? Then join our NTBHA team. We have proved to be a strong, self-sufficient and enduring foundation within our community. We are committed to connecting and serving our clients where they live. 

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. This position’s actions and work must align with NTBHA values and goals, regulations, policies and procedures, and meet all documentation standards and regulatory requirements. 

The Utilization Management (UM) Department is responsible for ensuring individuals receive medically necessary, appropriate, and timely behavioral health services through utilization review, authorization management, funding determinations, and regulatory compliance. The department works collaboratively with hospitals, providers, managed care organizations, and internal stakeholders to support continuity of care and responsible stewardship of public behavioral health resources.

The Utilization Management (UM) Manager is responsible for conducting clinical utilization reviews, determining funding eligibility and medical necessity, authorizing behavioral health services, and ensuring compliance with HHSC requirements, Texas Administrative Code (TAC), Texas Resilience and Recovery (TRR) standards, and NTBHA policies and procedures. This position collaborates with contracted providers, hospitals, managed care organizations, and internal departments to promote appropriate utilization of services, support continuity of care, maintain accurate clinical documentation, and improve system performance. This position reports to the Director of Utilization Management.

Travel may be required as part of this role’s duties.   Travel can vary from 20% to 100% per day. This would include all counties within NTBHA Catchment area (Dallas, Ellis, Hunt, Kaufman, Navarro & Rockwall Counties). 
This role may be required to use a fleet vehicle and/or a personal vehicle for business needs.  This may include, but is not limited to field & home visits, offsite meetings, co-located sites and/or pick up items for business needs, etc.  If your program requires transport of individuals, this would only be allowed with a company vehicle and approval from management. 

This position is classified as exempt and requires flexibility in scheduling to meet organizational needs, including adjusting work hours as necessary to ensure job responsibilities are completed.
 

Qualifications Required: 

• Licensed Practitioner of the Healing Arts (LPHA) in the state of Texas, RN, RN-APN, PA, LPC, LCSW or
• LMFT.
• At least three (3) years of 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 one (1) year of experience with the implementation of utilization management policies, procedures, and protocols for MH services, either as a provider or manager; at least one-year experience supervising MH providers.
• Working knowledge of behavioral health systems of care, Texas Resilience and Recovery (TRR) program rules, regulations, and guidelines, and familiarity with the Texas Administrative Code (TAC) preferred.
• Valid Texas driver's license.

Job Duties, Responsibilities, and Skills: 

• Work autonomously and make clinical 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 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.
• Able to work effectively in a fast-paced environment.
• Consistently meets productivity, schedule adherence, and quality standards while maintaining good attendance.
• Communicates effectively and uses strong interpersonal skills.
• 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.
• Data entry, maintaining files and reports, and performing other routine office work are required in this position.
• Review and approve Uniform Assessments (UA) in CMBHS.
• Review and approve SUD SARs in CMBHS.
• Performs administrative review of legal documentation to complete Single Port Authority (SPA) bed letters and provide recommendations regarding Orders of Protective Custody (OPC) in accordance with applicable laws, regulations, and NTBHA policies.
• Monitor compliance with and for various contracts entered into by NTBHA, including with the State of Texas.
• Work is achieved under general supervision with considerable latitude for the use of initiative and independent judgment.
• Participates in departmental meetings, trainings, provider education, and special projects while promoting collaboration between Quality Management and Utilization Management functions.
• Proficient professional oral and written communication.

• Advanced Microsoft Office Suite skills - Outlook, Word, Excel, PowerPoint, etc., with an ability to become familiar with company-specific programs and software. 

• Must be able to work on and have knowledge of a PC (personal computer). 

• Duties and projects may be assigned or changed to meet business needs. 

Benefits: 

• 457(b) 

• Paid time off 

• Health, Dental and Vision insurance 

• Health savings account 

• Flexible spending account 

• Tuition reimbursement 

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.