System Director of Utilization Review & Revenue Optimization

Baylor Scott & White Health; Dover; Remote; GBP 90.000 - 130.000; Vollzeit

Zusammenfassung

Baylor Scott & White Health is seeking a Director of Utilization Review to provide strategic leadership across the UR functions, ensuring medical necessity determinations are robust, compliant, and well documented. The role partners with clinical and revenue cycle leaders to drive system-wide performance improvements and reduce payer denials.

The director translates strategic plans into operational plans, directs daily UR operations, and oversees a mix of remote and on-site staff plus global

Qualifikationen

• EDUCATION - Masters Degree
• EXPERIENCE - (5) Five Years of Experience
• CERTIFICATION/LICENSE/REGISTRATION - Registered Nurse (RN)
• Specialty Certification (SPEC)

Aufgaben

• Directs daily operations of utilization review functions and policies.
• Develops metrics and executive reports for leadership and medical staff.
• Partners with Physician Advisors and regional leadership to improve outcomes.
• Streamlines workflows to reduce redundancies and improve employee experience.
• Works with revenue cycle leaders to reduce payer denials and streamline appeals.
• Oversees remote and global resources and vendor services.

Kenntnisse

Leadership

Communication

Critical thinking

Presentation

Stakeholder management

Ausbildung

Masters degree

RN license

Bachelor's degree in nursing or related field

Tools

Epic

XSOLIS

InterQual

AI tools

Jobbeschreibung

Baylor Scott & White Health is seeking a Director of Utilization Review to provide strategic leadership across the UR functions, ensuring medical necessity determinations are robust, compliant, and well documented. The role partners with clinical and revenue cycle leaders to drive system-wide performance improvements and reduce payer denials.

The director translates strategic plans into operational plans, directs daily UR operations, and oversees a mix of remote and on-site staff plus global