Assistant Director, Utilization Review - RN Leader

Nexus Enterprises, LLC; Schertz (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Nexus Enterprises, LLC in Schertz, TX seeks an Assistant Director of Utilization Review to lead the UR team, supervise staff, and drive data-driven process improvements. The role partners with the Director to oversee production metrics and regulatory compliance.

The position emphasizes analysis of complex data, coordination of pre-authorization and retrospective reviews, and development of training initiatives to enhance nurse performance and retention.

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; able to navigate through multiple software systems; knowledge of Microsoft Word, Excel, and Outlook.

Responsibilities

• Lead, supervise, and train the Utilization Review team in partnership with the Director, Utilization Review; ensure optimal workload distribution and performance.
• Analyze data for individual performance evaluations of UR Nurses.
• Establish and monitor workflow processes and production goals; collect, analyze, and report complex metrics.
• Stay current with regulatory changes and communicate updates to UR Nurses.
• Develop strategies for nurse retention and incentive programs; designs educational initiatives.
• Assist in case audits for nurses in training and provide actionable insights for quality development.
• Distribute cases during training to ensure exposure to different categories, clients, and state guidelines.
• Support call coverage and address questions during nurses' initial training period.
• Conduct intermittent utilization and quality reviews; participate in pre-authorization, concurrent, and retrospective reviews.

Skills

Leadership

Data analysis

Report writing

Medical terminology

Regulatory understanding

Communication

Education

BSN

Managed Care experience

Tools

Microsoft Word

Excel

Outlook

Job description

Nexus Enterprises, LLC in Schertz, TX seeks an Assistant Director of Utilization Review to lead the UR team, supervise staff, and drive data-driven process improvements. The role partners with the Director to oversee production metrics and regulatory compliance.

The position emphasizes analysis of complex data, coordination of pre-authorization and retrospective reviews, and development of training initiatives to enhance nurse performance and retention.