Supervisor Utilization Review RN

Baylor Scott & White Health; Dallas (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Baylor Scott & White Health in Dallas, TX seeks a supervisor to oversee Utilization Review for RNs and guide daily processes. The role focuses on complex case guidance, staff education opportunities, and interdepartmental communication to enhance care quality.

Responsibilities include supervising the UR department, generating weekly performance reports, and serving as SME for UR workflow issues and denials, with collaboration across Medical Director and Care Coordination teams.

Qualifications

• Education: Associate's Degree in Nursing.
• Major: Nursing.
• Experience: 4 years of experience.

Responsibilities

• Supervise Utilization Review Department, assign tasks, assess productivity, conduct quality reviews, and advise on peer-to-peer appeals.
• Collect data to generate weekly reports to improve staff outcomes and quality metrics.
• Collaborate with Medical Director and Care Coordination when patients don't meet criteria; update Clinical Resource Manager as needed.
• Assign daily tasks to staff to maintain optimal service levels.
• Monitor daily observation reports to identify and address potential problems.
• Handle escalations from Utilization Review Nurses and other staff.
• Conduct quality reviews as needed.
• Serve as SME for UR workflow issues, complex cases, denials, and customer interactions.

Skills

Mentoring

Communication

Collaboration

Microsoft Office

Discharge planning

Quality reviews

Education

Associate's Degree in Nursing

Tools

Microsoft Office Suite

EMR systems

Job description

Job Summary

You supervise utilization review for RNs. You oversee processes daily. Guide on complex cases. Identify staff education opportunities. Connect departments through communication.

Job Summary

You supervise utilization review for RNs. You oversee processes daily. Guide on complex cases. Identify staff education opportunities. Connect departments through communication.

Essential Functions Of The Role

• Supervising Utilization Review Department, assigning tasks, assessing productivity, conducting quality reviews, and advising team on peer-to-peer appeals. Also conducting denial research.
• Collecting data to generate weekly reports that aid in improving staff outcomes and enhancing quality metrics.
• Collaborate with the Medical Director and Care Coordination when patients don't meet criteria. Updating Clinical Resource Manager as needed.
• Assigning daily tasks to staff members to ensure service levels are maintained at an optimal level.
• Monitors daily observation reports to identify and address any potential problems.
• Handling escalations from Utilization Review Nurses and other staff members.
• Conducting quality reviews as needed.
• Responding to inquiries from staff members and stakeholders regarding Utilization Review.
• Serve as a Subject Matter Expert (SME) for Utilization Review workflow issues, complex cases, denials, and customer interactions, both internal and external.

Key Success Factors

• Possessing a helpful nature that assists others in identifying and solving challenges.
• Skilled in mentoring and encouraging colleagues for the enhancement of their clinical proficiency.
• Exceptional written and conversational abilities.
• Proficient at collaborating effectively with employees of varying ranks, including those at the highest level of leadership.
• Familiarity with discharge planning, case management, and utilization review. processes, case handling and the review of resource usage.
• Experience in strategically directing work among team members based on established policies and protocols.
• Aptitude in making sound hiring and termination suggestions.
• Proficiency in training colleagues and assessing their performance.
• Basic digital skills like using Microsoft Office, information security, managing schedules and payroll, electronic medical documentation, and email use

Qualification

• EDUCATION - Associate's Degree
• MAJOR - Nursing
• EXPERIENCE - (4) Four Years of Experience