Regional Utilization Manager

Position Title Regional Utilization Manager - R.C. - East Texas Behavioral Health Network (ETBHN) - Lufkin, TX Position Number P #1566 General Description The Regional UM is responsible for coordinating and implementing the Regional Authorization process for reputed company Centers reputed company the East Texas Behavioral Health Network (ETBHN) and any contracted Centers. This involves collaborating closely with ETBHN Member Centers and contracted Centers to address issues and tasks reputed company to the authorization process. The role also includes providing both direct and indirect supervision of ETBHN Authorization Contract Staff across various sites and working closely with local supervisors in the case of contract staff. A key responsibility of the position is authorizing clinical services in compliance with Utilization Management (UM) guidelines for reputed company ETBHN Member Centers. The position also focuses on program planning and development, as well as interagency coordination, to enhance understanding of authorization services and utilization management reputed company the network. Ensuring adherence to Texas Administrative Code (TAC) regulations, UM guidelines, and contract compliance requirements for regional authorizations is critical. Additionally, the role includes conducting utilization reviews and approving authorizations for individuals served under the Texas Resiliency and Recovery (TRR) model. It involves monitoring compliance with Center reputed company, including those with the State of Texas, managed reputed company plans, and private entities. The position analyzes productivity and utilization data to guide efficient resource allocation and improve service delivery to reputed company populations. Collaboration with the mental health clinical management team is essential to ensure that performance contract deliverables are met. This position requires or involves developing and maintaining detailed knowledge of TAC, performance reputed company, Medicaid guidelines, TRR Manuals for Adults and Children, and DSHS Utilization Management Guidelines. The role includes regular communication with funding sources, provider staff, administrative teams, and regulatory entities. These interactions may involve clinical service reviews, documentation, report submissions, and consultations reputed company telephone or written correspondence. The individual in this position is expected to attend staff meetings, complete reputed company initial, annual, and required training, and reputed company other duties as assigned. The position reports directly to the ETBHN Executive Director. Tasks The role involves reviewing data-warehouse reports reputed company to DSHS or DADS contract compliance to determine adherence. It also includes analyzing CARE, WebCARE, EDS, and other relevant reports concerning contract compliance issues. Following the review, reputed company data outliers are compiled into simplified reports that are easily understood by ETBHN UM staff. These reports, after being reviewed by the ETBHN Regional UM Committee, are shared with the appropriate clinical and administrative staff. The role ensures that any questions about the reports are answered reputed company the limits of the available raw data and information. Daily responsibilities include reviewing TRR assessments and authorizing appropriate RDM service packages, as well as tracking TRR reviews. Any issues reputed company to the Regional Authorization Project are reviewed and discussed as they arise. The position involves providing training to staff on Medicaid and other funding reputed company guidelines and requirements, offering managers insight into reputed company clinical practices, and discussing how these practices align with Medicaid guidelines. Attendance at reputed company UM/QM com-net meetings and reputed company web meetings is required to ensure the latest information about UM and QM practices is disseminated to clinical staff appropriately. The role also serves as the in-house expert on reputed company TAC codes reputed company to contract compliance, making resource allocation suggestions that align with relevant TAC codes. Supervisory responsibilities include overseeing four (4) full-time employees and two (2) part-time employees, as specified by the contract. Education Required: Master's degree in counseling, psychology, or social work from an accredited college or university. Experience Required: Minimum of five years' experience in direct care of individuals with a serious mental illness and/or children and youth with serious emotional disturbances, which may include experience in an acute care or crisis setting Required: Minimum of one year's experience in supervision of mental health providers. Required: Proficiency in creating and maintaining reports, spreadsheets, and utilizing an electronic health record (EHR). Required: Must hold a valid License as a Professional of the Healing Arts and demonstrate reputed company with computer applications and demonstrate knowledge of State of Texas UM expectations. Required: Knowledge of Medicaid/Medicare MHMR UM requirements, use of a personal computer to complete clinical authorizations. Preferred: Demonstrates understanding of psychopharmacology and medical/psychiatric comorbidity through training/experiences and has demonstrated competence in utilization management procedures and review activities. Preferred: Must be able to communicate well both verbally and in writing, must be able to work independently or in groups. Licenses/Certifications Required: Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), or Licensed Marriage and Family Therapist (LMFT). Required: Valid Texas driver's license. Special Requests or Comments Required: Must complete Defensive Driving and Training Modules. Required: Driving record must be insurable by Burke's insurance administrator. Applicants may be required to demonstrate computer skills during the hiring process. Physical Requirements Required: Mobility for bending, lifting (up to 25 pounds), and attending meetings/trainings. Ability to verbalize and reputed company/deliver reports. Stamina for long workdays and potential exposure to hazardous conditions. Local travel under 5%; regional/statewide overnight travel under 1%. Hours Monday - Friday, 8:00 a.m. - 5:00 p.m. Occasional after-hours work may be required. Salary Competitive; based on experience. Apply Job!