Supervisor – RN, Utilization Management

This is a fully remote position, open to applicants in Illinois, +3 more states.

📋 Description

• Oversee and manage daily operations of Utilization Management within designated regions or ministries.

• Handle referrals, assess medical necessity, and conduct reviews of experimental/investigational treatments, along with the application of medical policies and business processes.

• Review electronic medical records and evaluate clinical information using nationally recognized criteria.

• Ensure the quality, accuracy, and adherence to policy in UM review decisions.

• Adjust staffing patterns to ensure sufficient operational coverage.

• Assist in the development and maintenance of UM programs and ensure compliance with regulatory and accreditation standards.

• Monitor team accuracy, productivity, and performance metrics.

• Engage team members in opportunities for process improvement and standardized work practices.

• Assess staff involvement in projects to identify issues and enhance processes and systems.

• Encourage timely and effective communication among UM staff, Case Management staff, and healthcare providers.

• Serve as a leader and resource for staff while supporting team initiatives.

• Contribute to the hiring, training, leadership, and evaluation of staff.

• Apply evidence-based practices and scientific knowledge to nursing responsibilities.

• Perform additional duties as assigned.

⛳️ Requirements

• Ability to multitask along with strong communication skills.

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

• Two years of experience as a registered nurse and two years in utilization management.

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

• Required Registered Nurse (RN) license/certification for the state of the work location: Illinois, Missouri, Oklahoma, or Wisconsin.

• Frequent use of keyboard/data entry.

• Must reside within SSM Health's four-state footprint: Missouri, Illinois, Oklahoma, or Wisconsin.

🏝️ Benefits

• Regular employee status.

• Full-time schedule, comprising 40 scheduled weekly hours.

• Day shift, Monday–Friday during business hours.

• Equal employment opportunity protections.