System Director, Utilization Review & Denials Optimization

Baylor Scott & White Health; Dallas (TX); On-site; USD 180,000 - 240,000; Full time

Job summary

Baylor Scott & White Health is seeking a Director of Utilization Review to provide strategic leadership, planning, and oversight across UR functions. You will ensure medical necessity decisions, drive performance improvements, and reduce payer denials while aligning with regulatory requirements.

The role requires a Master's degree, RN licensure, and 5+ years in nursing or UR, with strong Epic experience. You will lead a remote and distributed team and collaborate with senior leaders to optimize

Qualifications

• Master's degree required.
• 5+ years of nursing or utilization review experience.
• RN license required.
• Leadership experience in a healthcare setting.
• Strong knowledge of Epic; XSOLIS preferred.

Responsibilities

• Directs utilization review operations and policies.
• Develops metrics and executive reporting for UR performance.
• Partners with clinical and revenue cycle leadership to reduce denials.
• Oversees remote BSWH staff and global resources in vendor support.
• Ensures CMS, JCAHO, and payer compliance for UR plans.

Skills

Leadership

Strategic planning

Regulatory compliance

Vendor management

Communication

Education

Masters Degree

RN license

Specialty Certification (SPEC)

Tools

Epic

XSOLIS

Job description

Baylor Scott & White Health is seeking a Director of Utilization Review to provide strategic leadership, planning, and oversight across UR functions. You will ensure medical necessity decisions, drive performance improvements, and reduce payer denials while aligning with regulatory requirements.

The role requires a Master's degree, RN licensure, and 5+ years in nursing or UR, with strong Epic experience. You will lead a remote and distributed team and collaborate with senior leaders to optimize