System Director, Utilization Review
B
Baylor Scott & White Health
📍 Boston, MA, United States
Job Description
**Job Summary**
Reporting to the Senior Vice President of Revenue Cycle, the Director of Utilization Review is responsible for the strategic leadership, planning, and oversight of utilization review (UR) functions across Baylor Scott & White Health (BSWH). This role ensures effective assessment, validation, and documentation of medical necessity for patient care services, including concurrent and retrospective denial prevention and management, regulatory compliance, and performance optimization. The Director partners closely with clinical, operational, and revenue cycle leadership to drive system-wide performance improvement initiatives, reduce payer denials, optimize the appeal process, and strengthen financial and regulatory outcomes.
A system Director translates and implements strategic plans and objectives for area of responsibility. Makes final decisions on operational matters and ensures achievement of objectives. Recommends policies and organizational changes for area. Pla...
Reporting to the Senior Vice President of Revenue Cycle, the Director of Utilization Review is responsible for the strategic leadership, planning, and oversight of utilization review (UR) functions across Baylor Scott & White Health (BSWH). This role ensures effective assessment, validation, and documentation of medical necessity for patient care services, including concurrent and retrospective denial prevention and management, regulatory compliance, and performance optimization. The Director partners closely with clinical, operational, and revenue cycle leadership to drive system-wide performance improvement initiatives, reduce payer denials, optimize the appeal process, and strengthen financial and regulatory outcomes.
A system Director translates and implements strategic plans and objectives for area of responsibility. Makes final decisions on operational matters and ensures achievement of objectives. Recommends policies and organizational changes for area. Pla...