**It's more than a career, it's a calling.** 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. Explore All Benefits (https://jobs.ssmhealth.com/us/en/benefits) _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. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?\_ga=2.205881493.704955970.1667719643-240470506.1667719643)_