Behavioral Health Utilization Review Nurse - Texas Behavioral Health Center

%3Cp class=%22MsoNormal%22%3E%3Cstrong%3ETexas Behavioral Health Center%3C/strong%3E%3C/p%3E%3Cp class=%22MsoNormal%22%3EThe Texas Behavioral Health Center is a%26nbsp;newly completed state-funded psychiatric hospital opening in Dallas’ Southwestern Medical District that is owned by the Texas Health and Human Services Commission (HHSC) and operated by UT Southwestern Medical Center.%3Cbr%3E%3Cbr%3EWhen fully operational, the 505,000-square-foot facility will house 292 beds – 200 for adult patients and 92 for children and adolescents. As DFW’s first state-funded behavioral health hospital, it is designed to deliver state-of-the-art, patient-centered care in a modern and healing environment. The center provides comprehensive behavioral health treatment and features private patient rooms, abundant access to natural light and nature, and thoughtfully designed spaces that promote recovery. The hospital will also provide training to all behavioral health disciplines.%3Cbr%3E%3Cbr%3EAs employees of UT%26nbsp;Southwestern, team members will join a world-class academic medical center committed to patient-centered care, innovation, interdisciplinary collaboration, and preparing patients for successful reintegration into their families and communities. With competitive

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and a mission-driven culture, Texas Behavioral Health Center offers an unparalleled opportunity to make a lasting impact on mental health care in North Texas.%26nbsp;%3Ca href=%22https%5C://jobs.utsouthwestern.edu/locations/texas-behavioral-health-center/%22%3ELearn more about Texas Behavioral Health Center here!%3C/a%3E%3C/p%3E%3Cp%3E%3Cstrong%3EWHY UT SOUTHWESTERN?%3C/strong%3E%3Cbr%3EWith over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and

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for our valued employees. Ranked as the No. 1 hospital in Dallas-Fort Worth according to %3Ci%3EU.S. News %26amp; World Report%3C/i%3E, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive

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package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you%27ll discover a culture of teamwork, professionalism, and a rewarding career!%26nbsp;%3Cbr%3E%3Cbr%3E%3Cstrong%3EJOB SUMMARY%3C/strong%3E%3Cbr%3EThe Inpatient Behavioral Health Utilization Management Nurse performs utilization management activities for patients receiving services at UT Southwestern%27s acute care behavioral health hospital. This role conducts prospective, concurrent, and retrospective reviews; maintains case documentation; communicates with payers; manages authorization requirements; and supports denial and appeal coordination in accordance with the hospital%27s Utilization Management Plan, approved criteria, payer requirements, and applicable regulations. The position collaborates with physicians and interdisciplinary teams to support appropriate level of care, medical necessity, length-of-stay management, timely transitions of care, optimal reimbursement, and quality improvement with minimal supervision.%26nbsp;%3Cbr%3E%3Cbr%3E%26nbsp;%3C/p%3E%3Cp%3E%3Cstrong%3EBENEFITS%3C/strong%3E%3Cbr%3EUT Southwestern is proud to offer a competitive and comprehensive

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package to eligible employees. Our

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are designed to support your overall wellbeing, and include%5C:%3C/p%3E%3Cul%3E%3Cli%3EPPO medical plan, available day one at no cost for full-time employee-only coverage%3C/li%3E%3Cli%3E100% coverage for preventive healthcare-no copay%3C/li%3E%3Cli%3EPaid Time Off, available day one%3C/li%3E%3Cli%3ERetirement Programs through the Teacher Retirement System of Texas (TRS)%3C/li%3E%3Cli%3EPaid Parental Leave Benefit%3C/li%3E%3Cli%3EWellness programs%3C/li%3E%3Cli%3ETuition Reimbursement%3C/li%3E%3Cli%3EPublic Service Loan Forgiveness (PSLF) Qualified Employer%3C/li%3E%3Cli%3E%3Cp%3E%3Ca href=%22http%5C://jobs.utsouthwestern.edu/

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/#top%22 target=%22_blank%22%3ELearn more about these and other UTSW employee

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!%3C/a%3E%3C/p%3E%3Cp%3E%26nbsp;%3C/p%3E%3C/li%3E%3C/ul%3E%3Cp%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3EEXPERIENCE AND EDUCATION%3C/strong%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3ERequired%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3E%3Cstrong%3EEducation%3C/strong%3E%3Cbr%3EGraduate of accredited nursing program and holds an active unrestricted RN license in the State of Texas%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cul%3E%3Cli%3E%3Cstrong%3EExperience%3C/strong%3E%3Cbr%3EFive to eight years of clinical experience in an inpatient psychiatric setting%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cul%3E%3Cli%3E%3Cstrong%3ELicenses and Certifications%3C/strong%3E%3Cbr%3E(RN) REGISTERED NURSE holds an active unrestricted RN license in the State of Texas.%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cp%3E%3Cstrong%3EPreferred%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3E%3Cstrong%3EExperience%3C/strong%3E%3Cbr%3EPrevious experience in an inpatient psychiatric setting with a focus on pediatric behavioral health is highly preferred%26nbsp;%3Cbr%3EAcute inpatient psychiatric nursing experience%26nbsp;%3Cbr%3EPrior experience with pediatric and adult behavioral health utilization review, managed care authorization, denial management, appeal coordination, electronic medical record systems, and utilization management documentation workflows is highly preferred%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cp%3E%3Cbr%3E%3Cstrong%3EJOB DUTIES%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3EConducts prospective, concurrent, and retrospective utilization reviews for inpatient behavioral health services using hospital-approved medical necessity criteria and applicable payer requirements to support appropriate level of care, continued stay, discharge readiness, length-of-stay management, and timely transitions of care.%3C/li%3E%3Cli%3ECompletes pre-certification, admission authorization, re-certification, and retrospective reviews for inpatient psychiatric services within established departmental and payer time frames.%3C/li%3E%3Cli%3EMaintains timely and accurate utilization review documentation in the electronic medical record, payer portals, and departmental tracking systems in accordance with established workflows and payer deadlines.%3C/li%3E%3Cli%3ECommunicates with physicians, physician advisors, mental health professionals, interdisciplinary treatment teams, discharge planning staff, outside agencies, managed care organizations, external reviewers, and other payers to obtain and submit clinical information, provide authorization updates, and address coverage barriers.%3C/li%3E%3Cli%3EParticipates in treatment team discussions to identify and communicate medical necessity, authorization, payer documentation, and level-of-care requirements for child, adolescent, and adult behavioral health populations.%3C/li%3E%3Cli%3EIdentifies cases that do not appear to meet medical necessity, continued stay, or appropriate level-of-care criteria and escalates them to physician advisors, attending physicians, and leadership for timely review and determination.%3C/li%3E%3Cli%3EIdentifies cases with complex payer, authorization, or discharge barriers and refers them to case management, discharge planning, or other appropriate resources.%3C/li%3E%3Cli%3EIdentifies and communicates documentation gaps that may affect medical necessity determinations, authorization, regulatory compliance, or reimbursement while maintaining physician and treatment team accountability for clinical documentation.%3C/li%3E%3Cli%3EAccurately documents and communicates authorization outcomes, avoidable days, payer barriers, denials, and other assigned utilization indicators to designated resources and leadership.%3C/li%3E%3Cli%3ESupports denial and appeal activities by communicating payer determinations, compiling relevant clinical information, facilitating peer-to-peer reviews, and completing assigned retrospective reviews and appeals within required time frames.%3C/li%3E%3Cli%3ECommunicates relevant clinical information to managed care organizations, external reviewers, and other payers to support review of medically necessary behavioral health services.%3C/li%3E%3Cli%3EIdentifies and communicates potential quality-of-care concerns, patient rights concerns, or regulatory issues to the Inpatient Behavioral Health Utilization Management Nurse Supervisor or other appropriate leadership in a timely manner.%3C/li%3E%3Cli%3EMaintains current knowledge of The Joint Commission, CMS, federal, state, local, and payer requirements affecting behavioral health utilization review, patient rights, reimbursement, and regulatory compliance.%3C/li%3E%3Cli%3EParticipates in department meetings, daily huddles, education, quality improvement activities, and assigned projects related to behavioral health utilization management.%3C/li%3E%3Cli%3EPerforms other appropriate behavioral health utilization management duties as assigned.%3C/li%3E%3C/ul%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%3Cstrong%3EKnowledge, Skills and Abilities%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul%3E%3Cli%3EDemonstrates knowledge of clinical criteria, managed care requirements, inpatient authorization processes, medical necessity review, denial management, appeal workflows, and reimbursement requirements for behavioral health services.%3C/li%3E%3Cli%3EDemonstrates working knowledge of The Joint Commission patient rights standards and applicable federal and state laws and regulations governing mental health care facilities, patient rights, utilization review, and reimbursement.%3C/li%3E%3Cli%3EAbility to work with child, adolescent, and adult behavioral health populations as demonstrated through education, training, or work experience.%3C/li%3E%3Cli%3EExceptional organizational, prioritization, documentation, follow-through, and data evaluation skills with the ability to manage multiple payer deadlines, competing priorities, and utilization management trends such as avoidable days, denial patterns, authorization barriers, and documentation gaps.%3C/li%3E%3Cli%3EStrong interpersonal, communication, assessment, advocacy, and collaboration skills with the ability to remain calm and poised when working with physicians, physician advisors, mental health professionals, nursing leadership, payers, agencies, patients, families, and team members.%3C/li%3E%3Cli%3EAbility to organize tasks and contribute to hospital goals, department objectives, regulatory compliance, quality improvement, and optimal reimbursement.%3C/li%3E%3Cli%3EBasic computer skills and ability to use electronic medical record systems, payer portals, telephonic review processes, and department tracking tools.%3C/li%3E%3Cli%3EIdentifies professional growth needs and seeks appropriate development opportunities in behavioral health utilization management, regulatory compliance, payer requirements, and clinical review criteria.%3C/li%3E%3Cli%3EGeneral good health and stress coping ability.%3C/li%3E%3Cli%3EAbility to speak and hear, to allow discussions with physicians, patients, families, payers, and other members of the healthcare team.%3C/li%3E%3Cli%3EPossess near vision acuity for accurate reading of computer screens and documentation in patient records.%3C/li%3E%3C/ul%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%3Cstrong%3EPHYSICAL REQUIREMENTS/WORKING CONDITIONS%3C/strong%3E%3C/span%3E%3C/p%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%3Cstrong%3EPhysical Requirements%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul%3E%3Cli%3ETalking%3C/li%3E%3C/ul%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%3Cstrong%3EWorking Conditions%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul%3E%3Cli%3EOffice Setting%3C/li%3E%3C/ul%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%26nbsp;%3C/span%3E%3C/p%3E%3Cp%3E%3Cstrong%3ESalary Information%3C/strong%3E%3Cbr%3ESalary is commensurate with education, skills, and relevant experience.%3Cbr%3E%3Cbr%3E%3Cstrong%3ESECURITY AND EEO STATEMENT%3C/strong%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3ESecurity%3C/strong%3E%3Cbr%3EThis position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.%3Cbr%3E%3Cbr%3E%3Cstrong%3EEEO%3C/strong%3E%3Cbr%3EUT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.%3Cbr%3E%26nbsp;%3C/p%3E