Strategic Director, Utilization Review

Baylor Scott & White Health; United States; On-site; USD 180,000 - 240,000; Full time

Job summary

Baylor Scott & White Health seeks a Director of Utilization Review to lead UR strategy, policy, and operations across the system. You will guide concurrent and retrospective reviews, ensure regulatory compliance, and drive performance improvements with clinical and revenue-cycle leaders.

This role partners with Physician Advisors and senior leadership to reduce denials, improve patient outcomes, and streamline processes using Epic, XSOLIS, and other tools.

Qualifications

• Requires Master's degree in nursing or related field.
• RN license and current registration.
• 5+ years in nursing/utilization review or related area.

Responsibilities

• Directs utilization review policy development and operational plans.
• Manages daily UR operations, metrics, and executive reporting.
• Partners with physicians and regional leaders to improve outcomes and utilization.
• Oversees vendor relationships and remote/global resources.

Skills

Leadership

Strategic planning

Communication

Process improvement

Healthcare administration

Education

Bachelor's degree in nursing or related field

Master's degree

Tools

Epic

XSOLIS

InterQual

Job description

Baylor Scott & White Health seeks a Director of Utilization Review to lead UR strategy, policy, and operations across the system. You will guide concurrent and retrospective reviews, ensure regulatory compliance, and drive performance improvements with clinical and revenue-cycle leaders.

This role partners with Physician Advisors and senior leadership to reduce denials, improve patient outcomes, and streamline processes using Epic, XSOLIS, and other tools.