Assistant Director, Utilization Review

Nexus Enterprises LLC; Schertz (TX); On-site; USD 110,000 - 140,000; Full time

Job summary

Nexus Enterprises LLC seeks an Assistant Director, Utilization Review to lead and mentor the UR team onsite in Schertz, TX. You will partner with the Director to drive data-driven reviews, optimize workflows, and ensure adherence to medical necessity standards.

The role requires a BSN with UR experience, strong regulatory knowledge, and proven leadership. You will develop training programs, perform audits, and produce clear, professional reports for management.

Qualifications

• BSN with 1–2 years’ experience in a Managed Care setting.
• Experience with various state evidence-based medicine guidelines.
• Experience in a previous management role is preferred.
• Proficient computer skills; navigate through multiple software systems; knowledge of Word, Excel, and Outlook.

Responsibilities

• Lead and supervise UR team and training activities.
• Analyze data to evaluate performance of UR nurses.
• Establish and monitor UR workflows and production goals.
• Communicate regulatory updates to UR staff promptly.
• Develop nurse retention and incentive strategies.
• Design and deliver educational initiatives for staff.
• Assist in case audits and provide actionable quality insights.
• Distribute cases during training for broad exposure.
• Support call coverage for nurses in training.
• Conduct intermittent utilization and quality reviews.
• Perform pre-authorization, concurrent, and retrospective reviews.
• Produce high-quality, well-structured reports.
• Dictate report content clearly to stakeholders.
• Coordinate with team and vendors effectively.

Skills

Leadership

Data analysis

Regulatory knowledge

Communication

Team training

Education

BSN

RN license

Tools

Microsoft Word

Excel

Outlook

Job description

Nexus Enterprises LLC seeks an Assistant Director, Utilization Review to lead and mentor the UR team onsite in Schertz, TX. You will partner with the Director to drive data-driven reviews, optimize workflows, and ensure adherence to medical necessity standards.

The role requires a BSN with UR experience, strong regulatory knowledge, and proven leadership. You will develop training programs, perform audits, and produce clear, professional reports for management.