Supervisor -RN, Utilization Management

Job description

It's more than a career, it's a calling MO-REMOTE Worker Type: Regular Job Highlights: Join a team where your work matters—every moment, every patient, every community. At SSM Health, you’ll be empowered to grow, supported to thrive, and inspired to make a lasting impact. Bring your clinical expertise and leadership experience to our Supervisor - RN, Utilization Management role, where you’ll guide and develop RN professionals, promote consistent utilization management practices, and help navigate complex medical necessity, patient status, authorization, and provider communication needs. Make an impact by supporting both your team and the patients and communities we serve. The selected candidate must reside in our four state footprint, MO, IL, OK or WI. M-F - Business Hours

Responsibilities

Requirements

• ability to multitask and strong communication skills A minimum of 2 years experience in Utilization Review/Utilization Management is required. Apply today. SSM Health – We bring out the incredible in you, everyday! Job Summary: Responsible for the oversight and management of daily operations within assigned region(s) or ministries related to the Utilization Management (UM) Review area under the direction of managers. Interacts directly with UM staff, Case Management staff, and providers. Exercises discretion and independent judgment that directly supports UM activities. Job Responsibilities and Requirements: PRIMARY RESPONSIBILITIES • Responsible for daily Utilization Management (UM) operations, which includes referrals, medical necessity and experimental/investigational reviews, application of medical policies, and business processes. Reviews electronic medical record and screens clinical information with nationally recognized criteria. • Ensures the quality and accuracy of UM review decisions and adherence to policy. • Adjusts staffing patterns to provide adequate coverage for UM operations during absences and vacancies. • Assists with the development and maintenance of UM programs and adherence to regulatory and accreditation requirements. • Ensures team meets performance metrics including accuracy and productivity based on departmental guidelines. • Actively engages team members in participating with the team regarding opportunities for improvement in standard work. • Reviews and evaluates staff participation, individually and as a team member, on projects to identify problems and improve work processes and systems. • Promotes timely and effective communication based on individual and/or situational requirements and utilizes appropriate means to ensure adequate information flow. • Acts as a leader and a resource to staff. Works collaboratively and supports the efforts of team members. • Provides input for hiring, training, leading and evaluating staff. • Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service. • As an SSM Health nurse, I will demonstrate the professional nursing standards defined in the professional practice model. Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and nursing needs of our patients and our patient populations. • Performs other duties as assigned. • Bachelor's degree in nursing or equivalent years of nursing education and experience • Two years' registered nurse experience and two years' utilization management experience

About SSM Health

SSM Health is a healthcare system that hires nurses for utilization management and care coordination roles. As a Manager Registered Nurse in Utilization Management, you would lead a team overseeing care coordination, utilization review, and regulatory compliance across the continuum of care, with responsibilities including managing denials and appeals, analyzing utilization data, and ensuring patients receive appropriate care while maintaining cost-effectiveness. The position is fully remote for candidates residing in Missouri, Oklahoma, Illinois, or Wisconsin, with standard Monday-Friday hours and occasional weekend support.