Texas Health and Human Services
Managed Care Utilization Review Director
Texas Health and Human Services, Austin, Texas, us, 78716
Managed Care Utilization Review Director III
Join Texas Health and Human Services (HHSC) to lead Medicaid Managed Care Utilization Review (UR) teams in Austin, TX.
Posting Details
Posting Number: 11190
Closing Date: 12/16/2025
Salary Group: TEXAS-B-28
Pay Range: $7,716.66 - $13,051.00 per month
Shift: Day; Telework Eligible; Up to 10% Travel
Full Time, Exempt, Regular
Job Overview The Managed Care UR Director reports to the Deputy Associate Commissioner of UR and oversees three specialist teams: Acute Care UR, UR Operations, and Long Term Services and Supports UR. This role directs strategic direction, day‑to‑day management, and provides clinical and contract oversight of Medicaid managed care programs. The Director directs approximately 100 staff statewide and works closely with the Office of Medical Director leadership team.
Essential Job Functions
Attend work on a regular schedule and perform duties as assigned.
Direct and organize UR activities to ensure efficient, effective delivery in compliance with federal and state laws, policies, and HHSC guidance.
Manage, supervise, hire, and develop professional and management staff; provide effective leadership and hold staff accountable.
Represent HHSC at meetings, hearings, trials, legislative sessions, conferences, panels, and committees; communicate with external stakeholders.
Develop and implement the UR strategic plan, program goals, strategies, and initiatives; provide oversight of associated workplans.
Develop and apply techniques for evaluating program activities; analyze data sets and report findings for improvement.
Communicate program issues, updates, and changes to internal and external stakeholders promptly.
Develop and manage departmental budget and HHSC resources; assist in drafting legislative appropriations, federal funding, and grant requests.
Knowledge, Skills, and Abilities
Experience managing and directing complex programs, including executive or senior management roles.
Experience with Texas Medicaid managed care programs.
Knowledge of public health programs, federal and state laws, regulations, policies, and procedures related to Medicaid and UR.
Knowledge of human resource management, budgeting compensation, classification, performance management, selection procedures.
Skill in risk management, project/program management, communication (oral and written), report writing, presentation development.
Ability to develop and implement strategic plans, evaluate complex legislative directives, and oversee outsourced projects.
Ability to build and maintain effective working relationships and professional networks.
Initial Selection Criteria
8+ years of experience managing complex programs; 3+ years in executive/senior management.
Experience with Texas Medicaid managed care program.
3+ years leading or performing UR/utilization management.
Leadership role in a clinical setting or related experience.
Bachelor’s or Master’s degree in health sciences, public health, health care, or equivalent experience.
Registration, Licensure, and Preference None required. Preference may be given to candidates with degrees in health sciences or public health, and to those with relevant master’s level degrees (e.g., nursing, health care administration, public health).
ADA Accommodations HHSC commits to reasonable accommodations in the hiring and selection process for qualified individuals with disabilities. Contact the HHS Employee Service Center at 1‑888‑894‑4747 for assistance.
Pre‑Employment Checks and Work Eligibility Applicants may be required to pass background and other due diligence checks. HHSC uses E‑Verify; bring I‑9 documentation on the first day.
Telework Disclaimer Telework may be eligible; subject to state and agency telework policies and business needs.
EEO Statement Texas Health and Human Services is an equal opportunity employer and encourages applications from all qualified individuals, including active‑duty military, reservists, guardsmen, and veterans.
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Posting Details
Posting Number: 11190
Closing Date: 12/16/2025
Salary Group: TEXAS-B-28
Pay Range: $7,716.66 - $13,051.00 per month
Shift: Day; Telework Eligible; Up to 10% Travel
Full Time, Exempt, Regular
Job Overview The Managed Care UR Director reports to the Deputy Associate Commissioner of UR and oversees three specialist teams: Acute Care UR, UR Operations, and Long Term Services and Supports UR. This role directs strategic direction, day‑to‑day management, and provides clinical and contract oversight of Medicaid managed care programs. The Director directs approximately 100 staff statewide and works closely with the Office of Medical Director leadership team.
Essential Job Functions
Attend work on a regular schedule and perform duties as assigned.
Direct and organize UR activities to ensure efficient, effective delivery in compliance with federal and state laws, policies, and HHSC guidance.
Manage, supervise, hire, and develop professional and management staff; provide effective leadership and hold staff accountable.
Represent HHSC at meetings, hearings, trials, legislative sessions, conferences, panels, and committees; communicate with external stakeholders.
Develop and implement the UR strategic plan, program goals, strategies, and initiatives; provide oversight of associated workplans.
Develop and apply techniques for evaluating program activities; analyze data sets and report findings for improvement.
Communicate program issues, updates, and changes to internal and external stakeholders promptly.
Develop and manage departmental budget and HHSC resources; assist in drafting legislative appropriations, federal funding, and grant requests.
Knowledge, Skills, and Abilities
Experience managing and directing complex programs, including executive or senior management roles.
Experience with Texas Medicaid managed care programs.
Knowledge of public health programs, federal and state laws, regulations, policies, and procedures related to Medicaid and UR.
Knowledge of human resource management, budgeting compensation, classification, performance management, selection procedures.
Skill in risk management, project/program management, communication (oral and written), report writing, presentation development.
Ability to develop and implement strategic plans, evaluate complex legislative directives, and oversee outsourced projects.
Ability to build and maintain effective working relationships and professional networks.
Initial Selection Criteria
8+ years of experience managing complex programs; 3+ years in executive/senior management.
Experience with Texas Medicaid managed care program.
3+ years leading or performing UR/utilization management.
Leadership role in a clinical setting or related experience.
Bachelor’s or Master’s degree in health sciences, public health, health care, or equivalent experience.
Registration, Licensure, and Preference None required. Preference may be given to candidates with degrees in health sciences or public health, and to those with relevant master’s level degrees (e.g., nursing, health care administration, public health).
ADA Accommodations HHSC commits to reasonable accommodations in the hiring and selection process for qualified individuals with disabilities. Contact the HHS Employee Service Center at 1‑888‑894‑4747 for assistance.
Pre‑Employment Checks and Work Eligibility Applicants may be required to pass background and other due diligence checks. HHSC uses E‑Verify; bring I‑9 documentation on the first day.
Telework Disclaimer Telework may be eligible; subject to state and agency telework policies and business needs.
EEO Statement Texas Health and Human Services is an equal opportunity employer and encourages applications from all qualified individuals, including active‑duty military, reservists, guardsmen, and veterans.
#J-18808-Ljbffr