Remote RN Utilization Management Leader

SSM Health; Missouri; On-site; USD 110,000 - 160,000; Full time

Benefits offered by this job

Paid Parental Leave

DailyPay (flexible payment options)

Upfront Tuition Coverage

Job summary

SSM Health is seeking a Manager of RN Utilization Management to oversee system-wide UM activities and lead a high-performing team. The role blends clinical nursing expertise with strategic leadership to optimize care coordination, utilization review, and regulatory compliance across the continuum of care.

The position is fully remote with a preference for candidates in MO, IL, WI, or OK, and supports weekend coverage when needed.

Qualifications

• Extensive Utilization Management or Case Management background required.
• Strong knowledge of CMS, Medicare/Medicaid and commercial regulations.
• Experience leading large cross-functional teams at management level.
• Experience leading denials and appeals resolutions.

Responsibilities

• Oversee day-to-day UM operations and staff.
• Ensure quality and accuracy of UM review decisions.
• Develop and enforce policies ensuring regulatory compliance.
• Manage staffing, productivity, and budget adherence.
• Meet performance metrics and participate in committees.

Skills

Utilization Management experience

Case Management experience

CMS/Medicare/Medicaid knowledge

Cross-functional leadership

Denials and appeals

Data analysis

Change management

Staff development

Education

Bachelor's degree in nursing

Job description

SSM Health is seeking a Manager of RN Utilization Management to oversee system-wide UM activities and lead a high-performing team. The role blends clinical nursing expertise with strategic leadership to optimize care coordination, utilization review, and regulatory compliance across the continuum of care.

The position is fully remote with a preference for candidates in MO, IL, WI, or OK, and supports weekend coverage when needed.