Behavioral Health Clinical Reviewer

Date: Jul 21, 2025

Location:

AUSTIN, TX

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Functional Title: Behavioral Health Clinical Reviewer
Job Title: Program Specialist VI
Agency: Health & Human Services Comm
Department: UR Acute Care FTE 50
Posting Number: 7327
Closing Date: 08/20/2025
Posting Audience: Internal and External
Occupational Category: Healthcare Practitioners and Technical
Salary Group: TEXAS-B-23
Salary Range: $5,833.34 - $7,400.00
Pay Frequency: Monthly
Shift: Day
Additional Shift:
Telework: Eligible for Telework
Travel: Up to 5%
Regular/Temporary: Regular
Full Time/Part Time: Full time
FLSA Exempt/Non-Exempt: Exempt
Facility Location:
Job Location City: AUSTIN
Job Location Address: 701 W 51ST ST
Other Locations: Austin; Corsicana; Dallas; Garland; Grand Prairie; Mesquite
MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,86P0,88A0,88B0,8U000,OS,OSS,PERS,YN,YNS

This position reports to the Acute Care Utilization Review Manager in the Office of the Medical Director, Medicaid and CHIP Services Department. The Behavioral Health (BH) Analyst (Program Specialist VI) performs complex behavioral health managed care utilization review oversight and consultation related to the prior authorization (PA) and authorization of behavioral health services within Texas Medicaid. The position leads the MCO oversight activities and includes analysis of Medicaid Managed Care Organizations (MCO) behavioral health-related PA and authorization policies, procedures and protocols to determine risk of MCO over/under utilization of services. This analyst must understand utilization management and be familiar with evidenced based guidelines such as InterQual or MCG (Milliman) criteria for the determination of medical necessity. The Behavioral Health Analyst must have strong research skills for clinical practice and health care delivery and effectively synthesize findings for a clinical and political audience to determine appropriateness of MCO utilization management activities. Must be proactive in seeking input from other staff in the Medicaid/CHIP Division and demonstrate the ability to work as an effective team member with other divisions within HHSC. Participates in, and at time leads, committees, work groups or activities as requested. The analyst in this role provides expert consultation to staff, other agencies and external persons including legislators and MCOs that provide utilization management of behavioral health services. The analyst stays abreast of current national standards and requirements affecting the behavioral health aspects of the Texas Medicaid medical benefits.

Essential Job Functions (EJFs)

This position reports to the Acute Care Utilization Review Manager in the Office of the Medical Director, Medicaid and CHIP Services Department. The Behavioral Health (BH) Analyst (Program Specialist VI) performs complex behavioral health managed care utilization review oversight and consultation related to the prior authorization (PA) and authorization of behavioral health services within Texas Medicaid. The position leads the MCO oversight activities and includes analysis of Medicaid Managed Care Organizations (MCO) behavioral health-related PA and authorization policies, procedures and protocols to determine risk of MCO over/under utilization of services. This analyst must understand utilization management and be familiar with evidenced based guidelines such as InterQual or MCG (Milliman) criteria for the determination of medical necessity. The Behavioral Health Analyst must have strong research skills for clinical practice and health care delivery and effectively synthesize findings for a clinical and political audience to determine appropriateness of MCO utilization management activities. Must be proactive in seeking input from other staff in the Medicaid/CHIP Division and demonstrate the ability to work as an effective team member with other divisions within HHSC. Participates in, and at time leads, committees, work groups or activities as requested. The analyst in this role provides expert consultation to staff, other agencies and external persons including legislators and MCOs that provide utilization management of behavioral health services. The analyst stays abreast of current national standards and requirements affecting the behavioral health aspects of the Texas Medicaid medical benefits.

Knowledge, Skills, and Abilities (KSAs)

Knowledge of: Texas Medicaid policy related to behavioral health benefits; behavioral health PA/authorization and utilization management; behavioral health practice guidelines; behavioral health quality assessment, assurance, or improvement; behavioral health research; knowledge of HHSC programs including Medicaid/CHIP and managed care; medical vocabularies such as Diagnostic and Statistical Manual of Mental Disorders (DSM), International Classification of Diseases (ICD) and, Current Procedural Terminology (CPT).

Skill in: Computers, including Microsoft Office suite; project planning, evaluation, and implementation; establishing and maintaining effective working relationships with managers, co-workers, and other staff or program stakeholders.

Ability to: work independently and function effectively as a member of a team, and under tight deadlines with high volume workloads; Highly organized and manage several projects concurrently in a fast-paced environment and juggle competing priorities; detail and task oriented; highly proficient in the English language with excellent written, verbal, and interpersonal communication and presentation skills; effectively facilitate meetings, establish and advance agenda goals; write and implement policies, standards and procedures; interpret public health laws, rules, regulations and recommendations.

Registration, Licensure Requirements or Certifications

LCSW, LMFT, LPC or similar clinical license in behavioral health preferred. MSW or other advanced behavioral health degree without licensure may be considered for candidates with an emphasis in policy practice and administration or more than 1-year experience in utilization management.

Initial Screening Criteria

Work experience in behavioral health setting, experience working with the multiple county and state agencies associated with outpatient behavioral health contracts or clinical review of behavioral health prior authorizations. Experience in managed care PA/authorization and utilization management preferred.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.