RN - Utilization Management Leader (Remote)

SSM Health; Missouri; Hybrid; USD 90,000 - 110,000; Full time

Job summary

SSM Health seeks an experienced RN Supervisor in Utilization Management to lead and develop UM staff, guide medical necessity decisions, and support provider communication across multiple states. You will navigate complex patient status decisions and ensure UM practices meet policy and accreditation requirements.

The role emphasizes leadership, collaboration with UR staff and Case Management, and ongoing process improvement to optimize patient care within a four-state footprint (MO, IL, OK, WI).

Qualifications

• BSN or higher nursing degree required.
• Two years RN experience and two years in Utilization Review/Utilization Management required.
• Ability to multitask and strong communication skills.

Responsibilities

• Oversee daily Utilization Management operations within assigned region(s) under direction of managers.
• Interact with UM staff, Case Management staff, and providers to support UM activities.
• Ensure accuracy of UM review decisions and adherence to policy and regulatory requirements.
• Adjust staffing to provide adequate UM coverage during absences and vacancies.
• Develop and maintain UM programs and ensure alignment with accreditation standards.
• Promote timely and effective communication and serve as a resource to staff.

Skills

Multitasking

Communication

Education

BSN or higher in nursing

Job description

SSM Health seeks an experienced RN Supervisor in Utilization Management to lead and develop UM staff, guide medical necessity decisions, and support provider communication across multiple states. You will navigate complex patient status decisions and ensure UM practices meet policy and accreditation requirements.

The role emphasizes leadership, collaboration with UR staff and Case Management, and ongoing process improvement to optimize patient care within a four-state footprint (MO, IL, OK, WI).