The Division Director of Utilization Review, under the direction of the BSWH System Director of Clinical Resource Management,will provide leadership and oversight to hospital departments of utilization review for the assigned division. The Director is responsible for implementing consistent policies and practices across all facilities within the division and developing monitoring tools to ensure processes are adhered to and meet regulatory compliance standards.
WHAT IS EXPECTED (ESSENTIAL FUNCTIONS):
Directs daily UR operations for the division including budget, staffing, recruitment, performance management, training and special projects
Develops/revises/updates departmental policies and procedures, work processes and staffing plans
Establishes and monitors departmental performance indicators, goals and objectives that are consistent with the Revenue Cycle and BSWH strategic objectives, mission, vision and values
Develops and maintains management reports for senior leadership, hospital senior leadership and senior medical staff
Evaluates facilities' Utilization Management (UM) Plan on an annual basis and ensures the UM
Serves as liaison in the area of utilization review/management for hospital and physician leaders
Hires, evaluates, counsels, develops and manages Utilization Review Leadership in the division
Acts as backup to vacancies in management positions related to Utilization Review at assigned facilities
KNOWLEDGE, SKILLS AND ABILITIES:
Knowledge of InterQual or equivalent evidence based criteria for hospital admission
Computers skills including working knowledge of Excel
Executive presentation skills
Process redesign, project management change management
Bachelor's degree in Nursing
Master's degree preferred
5 plus year's related experience
For formal consideration please click here to apply.
Internal Number: 18010312
About Baylor Scott & White Health
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!