Manager | Utilization Management Services

Socket.dev; La Crosse (WI); On-site; USD 100,000 - 140,000; Full time

Benefits offered by this job

Comprehensive benefits package

Competitive retirement program

Job summary

Emplify Health in La Crosse, WI, seeks a Manager of Utilization Management Services to lead a team of about 20 professionals. You will drive appropriate level-of-care determinations, ensure regulatory compliance, and optimize reimbursement across the organization.

You'll collaborate with physicians and operational leaders to improve workflows and guide the adoption of new technologies, including AI-enabled tools, while fostering accountability and continuous improvement.

Qualifications

• Leadership experience supervising a healthcare team.
• Strong understanding of utilization management processes.
• Experience driving process improvements and change management initiatives.
• Active RN license in the state of practice or RHIT/RHIA credential as applicable.

Responsibilities

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

Skills

Leadership experience

Healthcare collaboration

Regulatory & compliance awareness

Change management mindset

Education

Associate degree in Nursing or Health Information Management with RHIT certification

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

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

Required

• 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

We're seeking an experienced healthcare leader who thrives in a dynamic, highly collaborative environment and brings:

• 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.

Equal Opportunity Employer

If you need assistance with any portion of the application or have questions about the position, please contact [e-mail] or call 608-775-0267.

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.