Utilization Management Leader — Drive Care & Compliance

Gundersen Health System; La Crosse (WI); On-site; USD 90,000 - 120,000; Full time

Job summary

Gundersen Health System in La Crosse, WI, is seeking a Manager of Utilization Management Services to lead a ~20-person team, ensuring medical necessity determinations, denials handling, and regulatory compliance. You will partner with physicians and leaders to optimize workflows and reimbursements, while guiding change and adopting innovative technologies.

The role emphasizes operational leadership, strategic planning, and a collaborative, improvement-driven culture within a values-based health

Qualifications

• Associate degree in Nursing or Health Information Management with RHIT certification.
• Active 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.

Responsibilities

• 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.

Skills

Leadership

Utilization Management

Regulatory Compliance

Team Management

Education

Associate degree in Nursing or Health Information Management

RHIT/RHIA certification

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

Job description

Gundersen Health System in La Crosse, WI, is seeking a Manager of Utilization Management Services to lead a ~20-person team, ensuring medical necessity determinations, denials handling, and regulatory compliance. You will partner with physicians and leaders to optimize workflows and reimbursements, while guiding change and adopting innovative technologies.

The role emphasizes operational leadership, strategic planning, and a collaborative, improvement-driven culture within a values-based health