Supervisor Utilization Review RN

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

Job summary

Baylor Scott & White Health is seeking an experienced supervisor to oversee the Utilization Review team of RNs. You will guide daily processes, research denials, and ensure adherence to criteria.

This role requires strong leadership, mentoring, and cross-functional coordination with Medical Director and Care Coordination to optimize patient care and resource use. The ideal candidate has a solid background in discharge planning, case management, and UR workflows, plus excellent written and verbal

Qualifications

• Associate’s degree in nursing is required.
• Four years of supervisory experience in utilization review or a closely related field preferred.
• Strong communication and mentoring skills are essential for leading a diverse team.

Responsibilities

• Supervise Utilization Review Department: assign tasks, monitor productivity, conduct quality reviews, and advise on appeals.
• Collect data for weekly reports to improve staff outcomes and quality metrics.
• Collaborate with Medical Director and Care Coordination when patients do not meet criteria.

Skills

Team supervision

Mentoring

Communication

Discharge planning

Case management

Utilization review

Education

Associate’s Degree in Nursing

Tools

Microsoft Office

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