oilandgas.org.uk
Utilization Management Director
oilandgas.org.uk, Dallas, Texas, United States, 75215
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:Manage the UM team, overseeing the granting of authorizations and conducting utilization reviews for behavioral health services based on clinical information provided by providers and internal criteria for medical necessity and appropriateness of care.Monitor compliance with various contracts entered by NTBHA, including those with the State of Texas and local entities.Assist in daily authorizations of inpatient private psychiatric bed (PPB) funding, data entry and tracking, and maintain UM staff schedule to ensure coverage.Perform routine office work, including data entry, maintaining files and reports.Exhibit excellent communication, organizational, and documentation skills while using multiple computer software applications, including Web CARE and CMBHS.Work under minimal supervision with considerable latitude for the use of initiative and independent judgment.Chair the NTBHA Quarterly QM/UM Committee.Complete the UM Program Self-Assessment required by HHSC.Attend all local and statewide meetings/workgroups as requested by the supervisor.Provide community development trainings as needed.
Required Skills and Abilities:Work autonomously and 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 and local authority/service coordination principles.Communicate effectively with individuals from diverse cultural and socio-economic backgrounds through oral and written communication.Work constructively and efficiently with other professionals, community representatives, and family members.Foster strong, positive, and effective working relationships with inter-agency and intra-agency team members.Possess advanced Microsoft Office Suite skills with the 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 of experience in direct care of persons with serious mental illness, documented training in psychopharmacologic management, and medical/psychiatric co-morbidity.At least five years of experience as a member of a treatment team developing and monitoring 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; at least one year's experience supervising MH providers.
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 that is free of perceived harassment, racism, and discrimination, fostering understanding and compassion for all lived experiences.
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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:Manage the UM team, overseeing the granting of authorizations and conducting utilization reviews for behavioral health services based on clinical information provided by providers and internal criteria for medical necessity and appropriateness of care.Monitor compliance with various contracts entered by NTBHA, including those with the State of Texas and local entities.Assist in daily authorizations of inpatient private psychiatric bed (PPB) funding, data entry and tracking, and maintain UM staff schedule to ensure coverage.Perform routine office work, including data entry, maintaining files and reports.Exhibit excellent communication, organizational, and documentation skills while using multiple computer software applications, including Web CARE and CMBHS.Work under minimal supervision with considerable latitude for the use of initiative and independent judgment.Chair the NTBHA Quarterly QM/UM Committee.Complete the UM Program Self-Assessment required by HHSC.Attend all local and statewide meetings/workgroups as requested by the supervisor.Provide community development trainings as needed.
Required Skills and Abilities:Work autonomously and 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 and local authority/service coordination principles.Communicate effectively with individuals from diverse cultural and socio-economic backgrounds through oral and written communication.Work constructively and efficiently with other professionals, community representatives, and family members.Foster strong, positive, and effective working relationships with inter-agency and intra-agency team members.Possess advanced Microsoft Office Suite skills with the 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 of experience in direct care of persons with serious mental illness, documented training in psychopharmacologic management, and medical/psychiatric co-morbidity.At least five years of experience as a member of a treatment team developing and monitoring 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; at least one year's experience supervising MH providers.
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 that is free of perceived harassment, racism, and discrimination, fostering understanding and compassion for all lived experiences.
#J-18808-Ljbffr