Remote RN Utilization Management Leader

SSM Health; United States; Remote; USD 110,000 - 140,000; Full time

Benefits offered by this job

Paid Parental Leave

Flexible DailyPay options

Upfront Tuition Coverage

Job summary

SSM Health is seeking a Manager of RN Utilization Management to lead a system‑wide UM team remote from MO. The role combines clinical expertise with strategic leadership to oversee utilization reviews, care coordination, and regulatory compliance, ensuring patients receive the right care at the right time.

Qualifications include a Bachelor’s in nursing, 2+ years RN experience, 5+ years UM experience, and at least 2 years in a leadership role. Strong CMS/Medicare/Medicaid knowledge is required.

Qualifications

• / Must have as minimum: RN licensure in applicable states.
• / 2+ years acute RN experience; 5+ years UM experience; 2+ years in progressive leadership.

Responsibilities

• Oversee department operations including referrals, medical necessity reviews, and policy implementation.
• Ensure UM review decisions meet quality standards and regulatory requirements.
• Develop and oversee policies, procedures, and staffing to maintain compliance and performance metrics.
• Manage staffing and productivity to cover UM operations during absences or vacancies.
• Monitor budgets and expenditures to align with financial guidelines.
• Represent UM in committees and cross‑functional teams.
• Recruit, engage, develop, and lead assigned staff.
• Support quality improvement initiatives and achievement of department goals.

Skills

Utilization Management

Case Management

CMS Regulations

Leadership

Denials & Appeals

Data Analysis

Change Management

Staff Collaboration

Education

Bachelor’s degree in nursing

Job description

SSM Health is seeking a Manager of RN Utilization Management to lead a system‑wide UM team remote from MO. The role combines clinical expertise with strategic leadership to oversee utilization reviews, care coordination, and regulatory compliance, ensuring patients receive the right care at the right time.

Qualifications include a Bachelor’s in nursing, 2+ years RN experience, 5+ years UM experience, and at least 2 years in a leadership role. Strong CMS/Medicare/Medicaid knowledge is required.