System Director: Utilization Review & Denials Strategy

Direct Jobs; United States; Remote; USD 140,000 - 200,000; Full time

Job summary

Baylor Scott & White Health seeks a Director of Utilization Review to provide strategic leadership over UR functions across the health system. You will drive policies, performance metrics, and collaboration with clinical and revenue cycle leaders to improve outcomes and financial performance.

The role emphasizes governance of regulatory compliance, concurrent and retrospective reviews, and process optimization across sites, with a focus on reducing denials and strengthening appeals efficiencies.

Qualifications

• Masters degree in nursing or related field.
• 5+ years in nursing or utilization review.
• 1+ year in a leadership role.
• Registered Nurse (RN) license.
• Strong Epic knowledge; XSOLIS familiarity preferred.
• Ability to collaborate with multiple departments and leaders.

Responsibilities

• Lead strategic and operational plans for utilization management.
• Direct daily UR operations and policy development.
• Develop metrics and executive reporting for leaders.
• Partner with physicians and regional leadership on initiatives.
• Streamline workflows to improve outcomes and experience.
• Reduce payer denials and optimize appeals process.

Skills

Leadership

Communication

Strategic planning

Problem-solving

Cross-functional collaboration

Education

Masters Degree

RN license

Tools

Epic

XSOLIS

Job description

Baylor Scott & White Health seeks a Director of Utilization Review to provide strategic leadership over UR functions across the health system. You will drive policies, performance metrics, and collaboration with clinical and revenue cycle leaders to improve outcomes and financial performance.

The role emphasizes governance of regulatory compliance, concurrent and retrospective reviews, and process optimization across sites, with a focus on reducing denials and strengthening appeals efficiencies.