Supervisor -RN, Utilization Management

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

It's more than a career, it's a calling

MO-REMOTE

Worker Type:

Regular

Job Highlights:

Join a team where your work matters—every moment, every patient, every community. At SSM Health, you’ll be empowered to grow, supported to thrive, and inspired to make a lasting impact.

Bring your clinical expertise and leadership experience to our Supervisor - RN, Utilization Management role, where you’ll guide and develop RN professionals, promote consistent utilization management practices, and help navigate complex medical necessity, patient status, authorization, and provider communication needs. Make an impact by supporting both your team and the patients and communities we serve.

The selected candidate must reside in our four state footprint, MO, IL, OK or WI.

M-F - Business Hours

Preferred Qualifications:

ability to multitask and strong communication skills

A minimum of 2 years experience in Utilization Review/Utilization Management is required.

Job Summary:

Responsible for the oversight and management of daily operations within assigned region(s) or ministries related to the Utilization Management (UM) Review area under the direction of managers. Interacts directly with UM staff, Case Management staff, and providers. Exercises discretion and independent judgment that directly supports UM activities.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Responsible for daily Utilization Management (UM) operations, which includes referrals, medical necessity and experimental/investigational reviews, application of medical policies, and business processes. Reviews electronic medical record and screens clinical information with nationally recognized criteria.
• Ensures the quality and accuracy of UM review decisions and adherence to policy.
• Adjusts staffing patterns to provide adequate coverage for UM operations during absences and vacancies.
• Assists with the development and maintenance of UM programs and adherence to regulatory and accreditation requirements.
• Ensures team meets performance metrics including accuracy and productivity based on departmental guidelines.
• Actively engages team members in participating with the team regarding opportunities for improvement in standard work.
• Reviews and evaluates staff participation, individually and as a team member, on projects to identify problems and improve work processes and systems.
• Promotes timely and effective communication based on individual and/or situational requirements and utilizes appropriate means to ensure adequate information flow.
• Acts as a leader and a resource to staff. Works collaboratively and supports the efforts of team members.
• Provides input for hiring, training, leading and evaluating staff.
• Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service.
• As an SSM Health nurse, I will demonstrate the professional nursing standards defined in the professional practice model. Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and nursing needs of our patients and our patient populations.
• Performs other duties as assigned.

EDUCATION

• Bachelor's degree in nursing or equivalent years of nursing education and experience

EXPERIENCE

• Two years' registered nurse experience and two years' utilization management experience

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS

State of Work Location: Illinois

• Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)

State of Work Location: Missouri

• Registered Nurse (RN) Issued by Compact State
• Or
• Registered Nurse (RN) - Missouri Division of Professional Registration

State of Work Location: Oklahoma

• Registered Nurse (RN) Issued by Compact State
• Or
• Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)

State of Work Location: Wisconsin

• Registered Nurse (RN) Issued by Compact State
• Or
• Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services

Work Shift:

Day Shift (United States of America)

Job Type:

Employee

Department:

8746030033 Sys Utilization Management

Scheduled Weekly Hours:

40

SSM Health is an Equal Opportunity Employer. SSM Health provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender, pregnancy, sexual orientation, gender identity, national origin, age, disability, protected veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local law. Read our notice of non-discrimination (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?_ga=2.205881493.704955970.1667719643-240470506.1667719643)