Manager, Registered Nurse – Utilization Management

🕒 August 7

🌽 Illinois, Oklahoma, +2 more states – Remote

🌽 Illinois – Remote 🌪️ Oklahoma – Remote 🏰 Missouri – Remote 🧀 Wisconsin – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

👻 Ghost score 36%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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SSM Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1872

🏥 Healthcare

🤝 Non-profit

💰 Grant on 2023-12

Healthcare • Non-profit

SSM Health is a Catholic, not-for-profit health system serving communities across the U. S. Midwest through an integrated network of hospitals, clinics, and care services. With locations in Illinois, Missouri, Oklahoma, and Wisconsin, SSM Health operates acute-care and specialty services (including teaching hospitals and level‑one trauma centers), emphasizes mission-driven, compassionate care, workforce development, and employee benefits, and supports flexible nursing and other clinical roles.

📋 Description

• Oversee system-wide day-to-day Utilization Management activities and services • Develop and lead a high-performing Utilization Management team • Manage referrals, medical necessity and experimental/investigational reviews, and application of medical policies and business processes • Ensure quality and accuracy of Utilization Management review decisions • Ensure adherence to Utilization Management and Care Management policies • Participate in policy development and oversee staff compliance with regulatory and accrediting standards • Oversee staffing and productivity and adjust staffing patterns for adequate operational coverage • Monitor and adhere to the budget and approve or monitor expenditures and purchases • Ensure the team meets performance metrics and work plan requirements • Represent Utilization Management on committees, task forces, work groups, and multidisciplinary teams • Assist with development, maintenance, and adherence of Utilization Management programs and processes • Participate in quality improvement and company and department goals • Recruit, engage, develop, lead, and manage assigned staff • Perform other duties as assigned

🎯 Requirements

• Extensive Utilization Management experience or Case Management experience • Strong understanding of CMS, Medicare & Medicaid, and Commercial regulations • Experience leading large cross-functional teams at a management level • Experience leading denials and appeals resolutions • Experience analyzing denial, authorization, and utilization data • Ability to embrace change and promote continuous improvement • Effective leadership through evolving priorities and organizational initiatives • Ability to foster accountability, collaboration, adaptability, and engagement • Ability to partner with staff, physicians, and operational leaders • Bachelor's degree in nursing • Two years' acute nursing registered nurse experience • Five years' utilization management experience • Two years' demonstrated progressive leadership experience • Required RN licensure for the applicable work location: Illinois RN license; Missouri RN license issued by a compact state or Missouri RN license; Oklahoma RN license issued by a compact state or Oklahoma RN license; Wisconsin RN license issued by a compact state or Wisconsin RN license

🏖️ Benefits

• Equal employment opportunities regardless of protected characteristics • Fully remote work arrangement • Standard Monday through Friday, 8:00 a.m. to 4:30 p.m. schedule • 40 scheduled weekly hours