System Utilization Strategy Leader

Baptist Memorial Health Care Corporation; Memphis (TN); On-site; USD 110,000 - 165,000; Full time

Job summary

Baptist Memorial Health Care Corporation in Memphis, TN, seeks a System Utilization Review Manager to provide system-level leadership for utilization review operations across the organization. This role ensures timely, accurate, and compliant review of patient status, medical necessity, level of care, payer authorization, and overall utilization management processes.

You will partner with Case Management, Physician Advisors, Revenue Cycle, Nursing, Quality, and hospital leadership to optimize

Qualifications

• RN license required and Bachelor’s degree in Nursing.
• Five+ years of progressive experience in utilization review/management.
• Strong knowledge of medical necessity criteria, payer authorization processes, CMS guidance, and regulatory requirements.
• Ability to analyze data, identify trends, and drive performance improvement.

Responsibilities

• Lead and oversee system utilization review processes to ensure compliance with policies, payer requirements, CMS CO(P) and regulatory standards.
• Provide operational oversight, coaching, and performance management for utilization review staff across facilities.
• Monitor patient status, medical necessity reviews, level-of-care determinations, and authorization workflows.
• Collaborate with Physician Advisors, Case Management leaders, Revenue Cycle, and clinical teams to resolve utilization barriers.
• Analyze utilization data, denial trends, avoidable days, length of stay, and authorization performance to identify opportunities for improvement.
• Develop and standardize utilization review workflows, policies, education, and best practices across the health system.
• Partner with Revenue Cycle, Managed Care, Compliance, and Quality teams to reduce avoidable denials and support accurate reimbursement.
• Serve as a subject matter expert for utilization management criteria, payer authorization requirements, regulatory guidance, and documentation standards.
• Support interdisciplinary communication and escalation processes to improve patient progression, discharge readiness, and throughput.
• Prepare reports, dashboards, presentations, and recommendations for leadership related to utilization review performance and improvement initiatives.

Skills

Leadership

Communication

Change-management

Data analysis

Collaboration

Regulatory compliance

Education

Bachelor’s degree in Nursing

Master’s degree in Nursing / Healthcare Administration / related field

Tools

Electronic Health Records (EHR) systems

Utilization management platforms

Payer portals

Job description

Baptist Memorial Health Care Corporation in Memphis, TN, seeks a System Utilization Review Manager to provide system-level leadership for utilization review operations across the organization. This role ensures timely, accurate, and compliant review of patient status, medical necessity, level of care, payer authorization, and overall utilization management processes.

You will partner with Case Management, Physician Advisors, Revenue Cycle, Nursing, Quality, and hospital leadership to optimize