Texas Licensed Utilization Review Director

Job Summary

Providing strategic leadership in a remote full-time capacity, the Texas Licensed Utilization Review Director will oversee utilization review functions, ensuring compliance and optimization of patient care services while collaborating with clinical and operational leaders to enhance performance and reduce payer denials.

Key responsibilities

• Directs daily operations of utilization review functions, implementing policies and procedures aligned with organizational objectives
• Develops metrics and executive-level reporting for senior leadership to track performance and improve patient outcomes
• Partners with revenue cycle teams to streamline processes, reduce denials, and enhance operational effectiveness

Required qualifications

• Master's degree in nursing or a related field
• 5+ years of experience in nursing, utilization review, or a related area
• 1+ years of experience in a leadership role
• Registered Nurse (RN) license
• Strong working knowledge of Epic; experience with XSOLIS preferred