Full-Time
Registered Nurse Manager
Utilization Management
SSM Health
11-50 employees
Operates hospitals, clinics, and health plans
No salary listed
Wisconsin, USA + 3 more
More locations: Oklahoma, USA | Missouri, USA | Illinois, USA
Remote
Applicants must reside in Missouri, Oklahoma, Illinois, or Wisconsin; preference is given to candidates in the St. Louis region.
Bachelor's
 Medical, Clinical & Veterinary (1) |
|---|
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- Extensive experience in Utilization Management or Case Management.
- Strong understanding of Centers for Medicare & Medicaid Services, Medicare and 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 to identify trends, opportunities, and areas for improvement.
- Ability to embrace change and promote continuous improvement.
- Effective leadership through evolving priorities and organizational initiatives.
- Ability to foster a culture of accountability, collaboration, adaptability, and engagement.
- Ability to serve as a trusted partner to staff, physicians, and operational leaders.
- Bachelor's degree in nursing.
- Two years of acute nursing registered nurse experience and five years of utilization management experience, including two years of demonstrated progressive leadership experience.
- Registered Nurse licensure appropriate to the state of work location: Illinois RN licensure; Missouri RN licensure issued by a compact state or Missouri licensure; Oklahoma RN licensure issued by a compact state or Oklahoma licensure; or Wisconsin RN licensure issued by a compact state or Wisconsin licensure.
- Oversee system-wide day-to-day operational management of Utilization Management activities and services and develop a high-performing team.
- Manage department operations, including referrals, medical necessity and experimental or investigational reviews, and application of medical policies and business processes.
- Ensure the quality and accuracy of Utilization Management review decisions and adherence to Utilization Management and Care Management departmental policies.
- Participate in policy development and oversee staff activities to ensure compliance with regulatory and accrediting standards.
- Oversee staffing and productivity and adjust staffing patterns to provide adequate coverage during absences and vacancies.
- Monitor and adhere to the budget and approve or monitor expenditures, purchases, and other actions for budget compliance.
- Ensure that the Utilization Management team meets performance metrics and work plan requirements.
- Represent Utilization Management on committees, task forces, work groups, and multidisciplinary teams as assigned.
- Assist with development, maintenance, and adherence of Utilization Management programs and processes.
- Assist with company and department goals, including quality improvement activities.
- Recruit, engage, develop, lead, and manage assigned staff.
- Analyze program and staff effectiveness.
- Exercise discretion and independent judgment supporting Utilization Management activities.
SSM Health is a Catholic, not‑for‑profit integrated health system serving the Midwest. It runs 23 hospitals, 490+ physician offices and outpatient centers, plus virtual and post‑acute care, as well as a health plan, a pharmacy benefit manager, and an accountable care organization. It coordinates care across the full continuum—from physician clinics to hospital care—while serving the uninsured and Medicaid populations and pursuing clinical research in oncology, pediatrics, and cardiovascular health. Its goal is to improve population health through coordinated, accessible care and expanded behavioral health access within a diversified, faith‑based nonprofit framework.
Company Size
11-50
Company Stage
N/A
Total Funding
N/A
Headquarters
N/A
Founded
N/A
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Simplify's Take
What believers are saying
- July 9, 2026 Lake Saint Louis cancer expansion adds infusion bays and SLUCare.
- April 29, 2026 SLU RN-to-BSN deal strengthens recruiting and retention.
- March 2026 Chesterfield YMCA clinic captures primary, behavioral, and wellness visits.
What critics are saying
- Doe v. SSM Health in Missouri state court alleges MyChart data sharing.
- January 31, 2026 Oklahoma Spine and Dean integrations distract leadership through 2027.
- Reimbursement pressure and multi-state overhead threaten margins and future staffing cuts.
What makes SSM Health unique
- SSM's hospital, physician, health plan, and pharmacy footprint spans four states.
- Saint Louis University partnership gives academic medicine, clinical trials, and RN-to-BSN pipeline.
- Behavioral Health Urgent Care and YMCA clinic extend access beyond emergency rooms.
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Benefits
Paid Parental Leave
Tuition Reimbursement
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