Manager | Utilization Management Services

Gundersen Health System; La Crosse (WI); On-site; USD 90,000 - 120,000; Full time

Job summary

Gundersen Health System in La Crosse, WI, is seeking a Manager of Utilization Management Services to lead a ~20-person team, ensuring medical necessity determinations, denials handling, and regulatory compliance. You will partner with physicians and leaders to optimize workflows and reimbursements, while guiding change and adopting innovative technologies.

The role emphasizes operational leadership, strategic planning, and a collaborative, improvement-driven culture within a values-based health

Qualifications

• Associate degree in Nursing or Health Information Management with RHIT certification.
• Active RN license in the state of practice, or RHIT/RHIA credential as applicable.
• Minimum of five years of Utilization Management experience.
• Supervisory or leadership experience within a healthcare environment.

Responsibilities

• Provide operational and administrative leadership for Utilization Management Services.
• Lead and develop a department of approximately 20 team members, including Utilization Management Specialists and support staff.
• Oversee utilization review operations, medical necessity determinations, denials management, and appeals processes.
• Partner with physicians, medical directors, clinicians, and organizational leaders to drive effective utilization management practices.
• Ensure compliance with regulatory, payer, and organizational requirements.
• Monitor department performance and align fiscal responsibility with reimbursement optimization goals.
• Lead workflow improvement initiatives and support the adoption of new technologies, including AI-enabled tools.
• Foster a culture of accountability, collaboration, continuous improvement, and adaptability.

Skills

Leadership

Utilization Management

Regulatory Compliance

Team Management

Education

Associate degree in Nursing or Health Information Management

RHIT/RHIA certification

Bachelor's degree in Nursing or Health Information Management with RHIA

Job description

Love + medicine is who we are, it's what we do, it's why people want to work here.

Scheduled Weekly Hours: 40 Manager | Utilization Management Services Location: La Crosse, WI (On-site) FTE: 1.0, Salaried Position Schedule: Monday through Friday, business hours. No weekends, holidays, or call requirements.

Position Overview

At Emplify Health, we are committed to creating healthier communities through exceptional patient care, innovation, and teamwork. This is a unique opportunity to lead our Utilization Management Services team during a time of exciting transformation and alignment across the organization. As Manager of Utilization Management Services, you'll play a key role in advancing best practices, optimizing workflows, and supporting the implementation of innovative technologies that enhance efficiency and outcomes. In this role, you'll provide leadership to a team of approximately 20 professionals while partnering closely with physicians, medical directors, and operational leaders. You'll help ensure appropriate level-of-care determinations, regulatory compliance, and reimbursement optimization while guiding your team through ongoing change and growth initiatives.

What You'll Do

• Provide operational and administrative leadership for Utilization Management Services.
• Lead and develop a department of approximately 20 team members, including Utilization Management Specialists and support staff.
• Oversee utilization review operations, medical necessity determinations, denials management, and appeals processes.
• Partner with physicians, medical directors, clinicians, and organizational leaders to drive effective utilization management practices.
• Ensure compliance with regulatory, payer, and organizational requirements.
• Monitor department performance and align fiscal responsibility with reimbursement optimization goals.
• Lead workflow improvement initiatives and support the adoption of new technologies, including AI-enabled tools.
• Foster a culture of accountability, collaboration, continuous improvement, and adaptability.

What You'll Bring

• Associate degree in Nursing or Health Information Management with RHIT certification.
• Active Registered Nurse (RN) license in the state of practice, or RHIT/RHIA credential as applicable.
• Minimum of five years of Utilization Management experience.
• Supervisory or leadership experience within a healthcare environment.

Preferred

• Bachelor's degree in Nursing or Health Information Management with RHIA certification.
• Three or more years of supervisory or leadership experience.
• Case Management certification (ACM or CMSA).
• Experience leading process improvement, workflow optimization, or change management initiatives.

Ideal Candidate Profile

• Deep expertise in Utilization Management and medical necessity review.
• Proven success leading teams through change and transformation initiatives.
• Strong communication and relationship-building skills with physicians, clinicians, and operational leaders.
• The ability to balance regulatory, financial, and patient-centered priorities.
• A forward-thinking mindset and enthusiasm for innovation, technology, and AI-enabled solutions.
• Strong critical thinking, decision-making, and problem-solving abilities.
• A collaborative leadership style focused on engagement, accountability, and continuous improvement.

What You'll Get

• Opportunity to lead a highly specialized team responsible for critical organizational and patient care outcomes.
• Meaningful involvement in workflow redesign, innovation initiatives, and future-state Utilization Management practices.
• A supportive leadership environment that values professional growth and development.
• Comprehensive benefits package and competitive retirement program.

About Emplify Health

Emplify Health, a partnership of Bellin Health and Gundersen Health System, is a leading not-for-profit, patient-centered healthcare network based in Green Bay and La Crosse, Wisconsin. With 11 hospitals and over 100 clinics, we serve communities across Wisconsin, Iowa, Minnesota, and Michigan's Upper Peninsula. Join us in making a meaningful difference in the lives of our patients and communities.

Join Us

If you're an experienced Utilization Management leader who is energized by operational excellence, innovation, and leading teams through meaningful change, we'd love to hear from you.

Equal Opportunity Employer

We inspire your best life by relentlessly caring, learning and innovating. This is our purpose.

Together with our values — belonging, respect, excellence, accountability, teamwork and humility — our pillars set our foundation and our future.

Equal Opportunity Employer

Around here, loving your job is part of the job. Join our mission in changing healthcare while finding a career you'll love!

Gundersen Health System offers a proud, local history spanning more than 100 years. Our personalized patient care model is only the beginning of what you will experience as we foster population health transformation and innovation to serve our communities and you. We've made it a priority to enrich the lives of our employees as they find a career they love. Using each employee’s unique talents and passions, Gundersen is committed to delivering exceptional patient and family-centered care to the communities we serve.

You can be part of an exciting, highly adaptable and mission-driven organization with a work environment that supports you personally and professionally and a work culture where you are valued and appreciated offering an employee-first culture, work-life balance, and career advancement & growth opportunities. This culture allows our organization to attract elite talent, like yourself!

What You Can Expect

• Empowerment to shape your work environment
• Encouragement to improve processes and create efficiencies, and support when seeking opportunities for growth
• Culture that encourages self-care and provides you with opportunities to be your best self at work and at home
• Competitive compensation and comprehensive benefits packages, as applicable, ensuring your comfort and well-being as a valuable team member
• Support for your career growth through Professional Development Opportunities, our Tuition Investment Program, Career Development Center, and online continuing education courses
• Inside our walls and our neighborhoods, we deliver world‑class medical care and the right amount of love
• We call it LOVE + MEDICINE and it’s more than our practice. It is who we are.

Gundersen Health System, based in La Crosse, WI, is the leading provider of primary and specialized care in western Wisconsin, southeast Minnesota, and northeast Iowa; serving more than 500,000 residents throughout 22 counties. Our physician-led, not-for-profit healthcare system includes a 325‑bed teaching hospital, tertiary referral center, and Level II Trauma Center; community clinics; 6 affiliate critical access hospitals; nursing homes; behavioral health services; vision centers; pharmacies; and air and ground ambulance services.

Together, we inspire your best life by relentlessly caring, learning, and innovating. We deliver Love + Medicine every day to change lives in our communities and enrich the lives of our employees.

Select Remote/Hybrid Eligible under More search to see our remote-eligible openings. A rewarding career and an excellent quality of life awaits you. Learn more about our excellence in patient care, education, research, culture, and something we call Love + Medicine at www.gundersenhealth.org/careers/life.