Mgr-RN, Utilization Management

SSM Health is a Catholic, not-for-profit, fully integrated health system dedicated to advancing innovative, sustainable, and compassionate care for patients and communities throughout the Midwest and beyond. The organization’s 40,000 team members and 13,900 providers are committed to fulfilling SSM Health’s Mission: “Through our exceptional health care services, we reveal the healing presence of God.” With care delivery sites in Illinois, Missouri, Oklahoma and Wisconsin, SSM Health includes hospitals, physician offices, outpatient and virtual care services, comprehensive home care and hospice services, a fully transparent pharmacy benefit company, a health insurance company and an accountable care organization. It is one of the largest employers in every community it serves. For more information, visit ssmhealth.com

It's more than a career, it's a calling. MO-REMOTE Worker Type Regular Job Summary: Oversees the system wide day-to-day operational management of Utilization Management (UM) activities and services and the development of a high performing team. Analyzes the effectiveness of programs and staff. Exercises discretion and independent judgment that directly supports UM activities.

Responsible for department operations, which includes referrals, medical necessity and experimental/investigational reviews, and application of medical policies and business processes. Ensures the quality and accuracy of Utilization Management (UM) review decisions, and the adherence to UM and Care Management departmental policies. Participates in the development of policies and oversee staff activities to ensure compliance with regulatory and accrediting standards. Oversees staffing and productivity and adjusts staffing patterns to provide adequate coverage for UM operations during absences and vacancies. Monitors and adheres to budget. Approves or monitors expenditures, purchases, and other actions to ensure compliance with budget guidelines. Ensures that the UM team meets performance metrics and work plan requirements. Represents UM in the participation on committees, task forces, work groups and multidisciplinary teams, as assigned. Assists with the development, maintenance, and adherence of UM programs and processes. Assists and participates in meeting company and department goals such as quality improvement activities. Recruits, engages, develops, leads, and manages assigned staff. Performs other duties as assigned.