Utilization Review RN Supervisor - Lead & Improve Care

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

Job summary

Baylor Scott & White Health in Dallas, TX seeks a supervisor to oversee Utilization Review for RNs and guide daily processes. The role focuses on complex case guidance, staff education opportunities, and interdepartmental communication to enhance care quality.

Responsibilities include supervising the UR department, generating weekly performance reports, and serving as SME for UR workflow issues and denials, with collaboration across Medical Director and Care Coordination teams.

Qualifications

• Education: Associate's Degree in Nursing.
• Major: Nursing.
• Experience: 4 years of experience.

Responsibilities

• Supervise Utilization Review Department, assign tasks, assess productivity, conduct quality reviews, and advise on peer-to-peer appeals.
• Collect data to generate weekly reports to improve staff outcomes and quality metrics.
• Collaborate with Medical Director and Care Coordination when patients don't meet criteria; update Clinical Resource Manager as needed.
• Assign daily tasks to staff to maintain optimal service levels.
• Monitor daily observation reports to identify and address potential problems.
• Handle escalations from Utilization Review Nurses and other staff.
• Conduct quality reviews as needed.
• Serve as SME for UR workflow issues, complex cases, denials, and customer interactions.

Skills

Mentoring

Communication

Collaboration

Microsoft Office

Discharge planning

Quality reviews

Education

Associate's Degree in Nursing

Tools

Microsoft Office Suite

EMR systems

Job description

Baylor Scott & White Health in Dallas, TX seeks a supervisor to oversee Utilization Review for RNs and guide daily processes. The role focuses on complex case guidance, staff education opportunities, and interdepartmental communication to enhance care quality.

Responsibilities include supervising the UR department, generating weekly performance reports, and serving as SME for UR workflow issues and denials, with collaboration across Medical Director and Care Coordination teams.