WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you’ll discover a culture of teamwork, professionalism, and a rewarding career! 

JOB SUMMARY
The Director of Utilization Management works under minimal supervision to provide leadership guidance to the Utilization Management (UM) team by planning, organizing and supervising the activities of the staff. Responsible but not limited to all UM related activities such as admission reviews, concurrent reviews, utilization trends, patterns, communication with physician advisors and utilization trend reports to the Utilization Review Committee. Coordinates with other departments to identify potential opportunities to facilitate organizational improvement and success. 

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!

  EXPERIENCE AND EDUCATION

  Required

• Education
  Bachelor’s Degree in Nursing (BSN) 
   

• Experience
  5 years related experience in a healthcare organization in a management, business development, or planning position. 
  Must have extensive knowledge of the utilization management process, including admission and concurrent reviews, appropriate status of the patients, peer to peer requirements, denial process, contracts, and applicable rules and regulations affecting reimbursement for healthcare services. 
  Proven record of identifying process improvement opportunities. 

Preferred

• Education
  Master’s Degree in Nursing (MSN) 
   

• Experience
  7 years progressively responsible related experience 

JOB DUTIES

• Manages and directs Utilization Management nurses and coordinators.
• Determines policies and procedures that incorporate best practices and ensure effective utilization reviews.
• Manages and monitors admission reviews to ensure patients are placed in the correct status, and concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way.
• Provides analysis and reports of significant utilization trends, patterns, and impacts to resources.
• Consults with physician advisors, faculty and other professionals to develop improved utilization of effective and appropriate services.
• Analyzes department processes for efficiency and effectiveness to ensure facilitation of optimum reimbursement while complying with government and private insurance policies.
• Presents analysis and reports of significant utilization trends, patterns, and impact to resources to the Utilization Review Committee.
• Manages, develops, and coaches staff, building on individual strengths and assists in setting professional goals.
• Develops orientation and ongoing department training to expand staff knowledge, confidence, proficiency in duties, and efficiency in productivity.
• Implements corrective actions and conducts performance evaluations.
• Compiles and maintains records, reports, and statistical information for evaluation and planning.
• Provides leadership, direction, and guidance on professional responsibilities and technical skills.
• Establishes and maintains effective lines of communication on Utilization Management related issues with both internal and external entities.
• Serves as the definitive resource to respond to inquiries related to Utilization Management.
• Represents Utilization Management at various committees, professional organizations, and physician groups as needed.
• Works closely with the Medical Director and physician advisors, ensuring value-based care and efficient resource utilization.
• Performs other duties as assigned.

SECURITY AND EEO STATEMENT

Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.