Systemwide Utilization Review Director

Baylor Scott & White Health; Austin (TX); On-site; USD 140,000 - 200,000; Full time

Job summary

Baylor Scott & White Health seeks a Director of Utilization Review to lead UR strategy, governance, and performance across the health system. This role ensures medical necessity decisions, manages concurrent and retrospective reviews, and strengthens financial and regulatory outcomes through cross-functional collaboration.

The Director partners with clinical and revenue cycle leadership to reduce payer denials, optimize appeals, and drive system-wide performance improvements while overseeing a

Qualifications

• Masters degree required.
• 5+ years in nursing, utilization review, or related area.
• 1+ year in a leadership role.
• RN license required.
• Strong working knowledge of Epic; XSOLIS experience preferred.
• Ability to build relationships with UR teams and senior leaders.
• Knowledge of InterQual or equivalent criteria.
• Experience collaborating across departments in a large healthcare org.
• Excellent problem-solving and communication skills.
• Innovative approach to streamlining UR processes.

Responsibilities

• Directs daily UR operations and policy development.
• Develops metrics and reporting for executive leaders.
• Leads strategic projects to improve patient outcomes and resource use.
• Collaborates with Physician Advisors and regional leaders.
• Streamlines workflows to reduce redundancies and improve outcomes.
• Oversees vendor contracts and a remote/global workforce.
• Ensures CMS, TJC, and payer compliance.

Skills

Leadership

Strategic planning

Stakeholder collaboration

Process improvement

Epic optimization

Education

Masters Degree

RN license

Tools

Epic

XSOLIS

InterQual

Job description

Baylor Scott & White Health seeks a Director of Utilization Review to lead UR strategy, governance, and performance across the health system. This role ensures medical necessity decisions, manages concurrent and retrospective reviews, and strengthens financial and regulatory outcomes through cross-functional collaboration.

The Director partners with clinical and revenue cycle leadership to reduce payer denials, optimize appeals, and drive system-wide performance improvements while overseeing a