Texas Health and Human Services
Overview
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. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, opportunities for career advancement and more. Functional Title:
Therapy Analyst Job Title:
Registered Therapist V Agency:
Health & Human Services Comm Department:
UR Acute Care FTE 75 Posting Number:
9092 Closing Date:
10/15/2025 Posting Audience:
Internal and External Occupational Category:
Healthcare Support Salary Group:
TEXAS-B-27 Salary Range:
$7,015.16 - $11,864.50 Pay Frequency:
Monthly Shift:
Day Telework:
Yes Travel:
Up to 10% Regular/Temporary:
Regular Full Time/Part Time:
Full time FLSA Exempt/Non-Exempt:
Exempt Facility Location:
701 W 51ST ST, AUSTIN, TX Job Location City:
AUSTIN Other Locations:
MOS Codes: 230X,42BX,42NX,42TX,65A,65B,68F,68L,HM,HN,HS,SEI12 Essential Job Functions All essential job functions must ensure compliance and knowledge of Texas Medicaid MCOs utilization management with HHSC contracts, state and federal regulations related to STAR Kids, STAR, STAR+PLUS, and STAR Health programs. The Registered Therapist V will review information requested by Acute Care Utilization Review from each MCO to determine if policies and procedures are in compliance with the Uniform Managed Care Manual and Uniform Managed Care Contract by completing internal audit tools. This employee will oversee the MCOs prior authorization criteria to determine medical necessity is consistent with amount, duration and scope in the Texas Medicaid Provider Procedures Manual. Using clinical expertise, review each PA request to ensure the MCO identifies critical elements in the clinical documentation to establish medical necessity, including assessment record, plan of care, and applicable codes; apply TMPPM and related regulations to determine amount and duration. Evaluate inconsistencies in utilization review and recommend process improvements. Provide concise summary input in discussions with MCO leadership. Plan and prepare for the review of identified cases in coordination with the therapy Clinical Review Manager and review cases using ACUR Tools. Identify and discuss errors or discrepancies in MCO systems and PA steps as evidenced in documentation. Conduct interviews with utilization management staff as applicable to the review process. Assist in preparing and disseminating post-review follow-up findings and monitor MCO activities related to non-compliance with utilization management. Develop and administer input related to rebuttal, reconsideration processes and Corrective Action Plans (CAPs) submitted by the MCOs for approval. Administer ACUR clinical and UM review tools to ensure accurate documentation of review findings and medical necessity for services. Complete tools at various stages of reviews and provide clinical review of complaints and inquiries to HHSC staff as needed. Lead and participate in provider trainings and inter- and intra-department trainings as needed. Qualifications Registrations, Licensure And Certification Requirements Must possess a current Texas Speech Language Pathology license. Initial Screening Criteria Master's degree in speech-language pathology required. Minimum 10 years of clinical experience. Experience with at least one of the following: Texas Medicaid, managed care, utilization review experience, or case management. Knowledge, Skills, And Abilities
Knowledge of Texas Medicaid policy related to skilled therapy benefits. Experience with therapy PA/authorization and utilization management; therapy practice guidelines; therapy quality assessment, assurance, or improvement; therapy research. Knowledge of HHSC programs including Medicaid/CHIP and managed care. Familiarity with ICD-10 and HCPCS/CPT codes. Excellent computer skills, including Microsoft Office suite. Ability to work independently and as part of a team, and under tight deadlines with high volume. Active Duty, Military, Reservists, Guardsmen, And Veterans Military occupation(s) that relate to the initial selection criteria and licensure requirements are listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified. ADA Accommodations HHSC and DSHS agencies will provide reasonable accommodations during the hiring process for qualified individuals with a disability. For assistance, contact the HHS Employee Service Center at 1-888-894-4747. Pre-Employment Checks And Work Eligibility Applicants may be required to pass background and other checks. HHSC uses E-Verify. Bring I-9 documentation on first day of work. Telework Disclaimer This position may be eligible for telework. Telework is subject to state and agency policies and business needs. Nearest Major Market:
Austin
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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. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, opportunities for career advancement and more. Functional Title:
Therapy Analyst Job Title:
Registered Therapist V Agency:
Health & Human Services Comm Department:
UR Acute Care FTE 75 Posting Number:
9092 Closing Date:
10/15/2025 Posting Audience:
Internal and External Occupational Category:
Healthcare Support Salary Group:
TEXAS-B-27 Salary Range:
$7,015.16 - $11,864.50 Pay Frequency:
Monthly Shift:
Day Telework:
Yes Travel:
Up to 10% Regular/Temporary:
Regular Full Time/Part Time:
Full time FLSA Exempt/Non-Exempt:
Exempt Facility Location:
701 W 51ST ST, AUSTIN, TX Job Location City:
AUSTIN Other Locations:
MOS Codes: 230X,42BX,42NX,42TX,65A,65B,68F,68L,HM,HN,HS,SEI12 Essential Job Functions All essential job functions must ensure compliance and knowledge of Texas Medicaid MCOs utilization management with HHSC contracts, state and federal regulations related to STAR Kids, STAR, STAR+PLUS, and STAR Health programs. The Registered Therapist V will review information requested by Acute Care Utilization Review from each MCO to determine if policies and procedures are in compliance with the Uniform Managed Care Manual and Uniform Managed Care Contract by completing internal audit tools. This employee will oversee the MCOs prior authorization criteria to determine medical necessity is consistent with amount, duration and scope in the Texas Medicaid Provider Procedures Manual. Using clinical expertise, review each PA request to ensure the MCO identifies critical elements in the clinical documentation to establish medical necessity, including assessment record, plan of care, and applicable codes; apply TMPPM and related regulations to determine amount and duration. Evaluate inconsistencies in utilization review and recommend process improvements. Provide concise summary input in discussions with MCO leadership. Plan and prepare for the review of identified cases in coordination with the therapy Clinical Review Manager and review cases using ACUR Tools. Identify and discuss errors or discrepancies in MCO systems and PA steps as evidenced in documentation. Conduct interviews with utilization management staff as applicable to the review process. Assist in preparing and disseminating post-review follow-up findings and monitor MCO activities related to non-compliance with utilization management. Develop and administer input related to rebuttal, reconsideration processes and Corrective Action Plans (CAPs) submitted by the MCOs for approval. Administer ACUR clinical and UM review tools to ensure accurate documentation of review findings and medical necessity for services. Complete tools at various stages of reviews and provide clinical review of complaints and inquiries to HHSC staff as needed. Lead and participate in provider trainings and inter- and intra-department trainings as needed. Qualifications Registrations, Licensure And Certification Requirements Must possess a current Texas Speech Language Pathology license. Initial Screening Criteria Master's degree in speech-language pathology required. Minimum 10 years of clinical experience. Experience with at least one of the following: Texas Medicaid, managed care, utilization review experience, or case management. Knowledge, Skills, And Abilities
Knowledge of Texas Medicaid policy related to skilled therapy benefits. Experience with therapy PA/authorization and utilization management; therapy practice guidelines; therapy quality assessment, assurance, or improvement; therapy research. Knowledge of HHSC programs including Medicaid/CHIP and managed care. Familiarity with ICD-10 and HCPCS/CPT codes. Excellent computer skills, including Microsoft Office suite. Ability to work independently and as part of a team, and under tight deadlines with high volume. Active Duty, Military, Reservists, Guardsmen, And Veterans Military occupation(s) that relate to the initial selection criteria and licensure requirements are listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified. ADA Accommodations HHSC and DSHS agencies will provide reasonable accommodations during the hiring process for qualified individuals with a disability. For assistance, contact the HHS Employee Service Center at 1-888-894-4747. Pre-Employment Checks And Work Eligibility Applicants may be required to pass background and other checks. HHSC uses E-Verify. Bring I-9 documentation on first day of work. Telework Disclaimer This position may be eligible for telework. Telework is subject to state and agency policies and business needs. Nearest Major Market:
Austin
#J-18808-Ljbffr