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 all Centers within 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 related 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 all 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 within 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 contracts, including those with the State of Texas, managed care health plans, and private entities. The position analyzes productivity and utilization data to guide efficient resource allocation and improve service delivery to target 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 contracts, 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 via telephone or written correspondence.

The individual in this position is expected to attend staff meetings, complete all initial, annual, and required training, and perform other duties as assigned. The position reports directly to the ETBHN Executive Director.

Tasks

The role involves reviewing data-warehouse reports related 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, all 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 within 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 related to the Regional Authorization Project are reviewed and discussed as they arise.

The position involves providing training to staff on Medicaid and other funding source guidelines and requirements, offering managers insight into current clinical practices, and discussing how these practices align with Medicaid guidelines. Attendance at all UM/QM com-net meetings and related 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 all TAC codes related 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 skill 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 develop/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.