Utilization Review Director (RN) - Permian Basin Behavioral Health Center - Midland, Texas

About the role

Signet Health manages the behavioral health services at Permian Basin Behavioral Health Center (PBBHC) in Midland, Texas. The Utilization Review (UR) Director (RN) is responsible for ensuring that all behavioral health patients receive the appropriate level of care and that all services rendered meet medical necessity, payer requirements, Texas behavioral health regulations, and DNV accreditation standards. The UR Director performs utilization review activities, concurrent reviews, precertifications, and discharge‑related authorization functions to support timely reimbursement and high‑quality patient care.

Responsibilities

• Utilization Management & Medical Necessity: Conduct admission, continued‑stay, and discharge reviews for all patients based on InterQual®, MCG, or payer‑specific medical necessity criteria, CMS Conditions of Participation (where applicable), and DNV NIAHO® Behavioral Health standards. Validate appropriate level of care (inpatient, PHP, IOP, detox, residential) and communicate variances to providers.
• Insurance & Authorization Management: Initiate pre‑certifications for admissions and transfers, perform concurrent reviews with commercial, Medicaid, Medicare Advantage, and managed‑care organizations, submit clinical documentation within required time frames, manage peer‑to‑peer requests, and track authorization numbers, approved days, and review dates in the EMR/UR software.
• Compliance & Accreditation (DNV / Texas‑specific): Ensure UR processes comply with DNV NIAHO®/ISO 9001 requirements, Texas Administrative Code Title 25—Behavioral Health Facility regulations, CMS, EMTALA (if applicable), and payer rules; participate in audits, tracer activities, and performance‑improvement projects; maintain documentation that meets DNV standards.
• Interdisciplinary Collaboration: Work with physicians, nursing, case management, therapy, social work, and admissions to coordinate patient flow and progression of care; attend daily treatment team meetings on assigned units; communicate authorization status, updates, and denials to clinical teams.
• Denial Prevention & Management: Identify potential denial risks early, assist with preparation of denial appeals by supplying clinical summaries and supporting documentation, and collaborate with billing and revenue cycle to ensure claims accuracy and timely submission.
• Documentation & Data Management: Enter all reviews, payer communications, and clinical updates into the EMR/UR tracking system; maintain UR logs, KPIs, and dashboards for LOS monitoring, denial rates, approval trends, payer mix, and reimbursement; report trends to leadership for process improvement.

Qualifications

• Current Texas RN license (unencumbered).
• Minimum 2 years psychiatric/behavioral health nursing experience.
• Experience with utilization review, case management, or managed care.
• Experience with Medicaid/Medicare behavioral health authorization processes.
• Knowledge of InterQual®/MCG criteria.
• Strong understanding of behavioral health diagnoses, treatment modalities, and levels of care.
• Excellent communication and negotiation skills.
• Prior UR/UM experience in a Texas behavioral health facility (strongly preferred).
• Familiarity with DNV Accreditation (NIAHO®/ISO 9001) (strongly preferred).
• Experience with EMRs such as Epic, Cerner, MediTech, or Sigmund (preferred).
• Clinical assessment and critical thinking; strong professional communication; time management and organization; ethical decision‑making; collaboration and conflict resolution; accuracy and attention to detail.

Work Location

This position is 100 % on‑site in Midland, Texas, at the new free‑standing psychiatric hospital operated by Signet Health.

About the Organization

Permian Basin Behavioral Health Center (PBBHC) is a brand‑new, mission‑driven organization transforming access to behavioral health care across West Texas and southeastern New Mexico. Team members help build programs, shape culture, and directly impact lives in a growing region with a strong sense of purpose and collaboration.

Living in Midland, Texas

Midland offers a high quality of life with affordable housing, short commutes, excellent schools, and a welcoming community. The city blends small‑city convenience with big‑opportunity energy, featuring a vibrant arts scene, outdoor recreation, and easy access to regional travel.