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MO-REMOTE

Worker Type:

Regular

Job Summary:

Oversees the system wide day-to-day operational management of Utilization Management (UM) activities and services and the development of a high performing team. Analyzes the effectiveness of programs and staff. Exercises discretion and independent judgment that directly supports UM activities.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

Responsible for department operations, which includes referrals, medical necessity and experimental/investigational reviews, and application of medical policies and business processes.Ensures the quality and accuracy of Utilization Management (UM) review decisions, and the adherence to UM and Care Management departmental policies.Participates in the development of policies and oversee staff activities to ensure compliance with regulatory and accrediting standards.Oversees staffing and productivity and adjusts staffing patterns to provide adequate coverage for UM operations during absences and vacancies.Monitors and adheres to budget. Approves or monitors expenditures, purchases, and other actions to ensure compliance with budget guidelines.Ensures that the UM team meets performance metrics and work plan requirements.Represents UM in the participation on committees, task forces, work groups and multidisciplinary teams, as assigned.Assists with the development, maintenance, and adherence of UM programs and processes.Assists and participates in meeting company and department goals such as quality improvement activities.Recruits, engages, develops, leads, and manages assigned staff.Performs other duties as assigned.

EDUCATION

Bachelor's degree in nursing

EXPERIENCE

Two years' registered nurse experience and three years' utilization management experience, with two years' of demonstrated progressive leadership 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

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). 

Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.

Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. 

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SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.