Supervisor – RN, Utilization Management

🔥 7 minutes ago

🌽 Illinois, Oklahoma, +2 more states – Remote

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

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 10%

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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 and manage daily Utilization Management operations within assigned regions or ministries • Manage referrals, medical necessity and experimental/investigational reviews, medical policy application, and business processes • Review electronic medical records and screen clinical information using nationally recognized criteria • Ensure quality, accuracy, and policy adherence of UM review decisions • Adjust staffing patterns to maintain adequate operational coverage • Assist with development and maintenance of UM programs and regulatory/accreditation compliance • Monitor team accuracy, productivity, and performance metrics • Engage team members in process improvement and standard work opportunities • Evaluate staff participation in projects to identify problems and improve processes and systems • Promote timely and effective communication among UM staff, Case Management staff, and providers • Act as a leader and resource to staff and support team efforts • Provide input for hiring, training, leading, and evaluating staff • Apply evidence-based practice and scientific knowledge to nursing practice • Perform other duties as assigned

🎯 Requirements

• Ability to multitask and strong communication skills • Minimum of 2 years of experience in Utilization Review/Utilization Management • Two years of registered nurse experience and two years of utilization management experience • Bachelor's degree in nursing or equivalent years of nursing education and experience • Required Registered Nurse (RN) license/certification for the state of work location: Illinois, Missouri, Oklahoma, or Wisconsin • Frequent keyboard use/data entry • Must reside in SSM Health's four-state footprint: Missouri, Illinois, Oklahoma, or Wisconsin

🏖️ Benefits

• Regular employee status • Full-time schedule, 40 scheduled weekly hours • Day shift, Monday–Friday during business hours • Equal employment opportunity protections

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