Scheduled Weekly Hours:
40
Manager | Utilization Management Services
Location: La Crosse, WI (On-site)
FTE: 1.0, Salaried Position
Schedule: Monday through Friday, business hours. No weekends, holidays, or call requirements.
Position Overview
At Emplify Health, we are committed to creating healthier communities through exceptional patient care, innovation, and teamwork. This is a unique opportunity to lead our Utilization Management Services team during a time of exciting transformation and alignment across the organization. As Manager of Utilization Management Services, you'll play a key role in advancing best practices, optimizing workflows, and supporting the implementation of innovative technologies that enhance efficiency and outcomes.
In this role, you'll provide leadership to a team of approximately 20 professionals while partnering closely with physicians, medical directors, and operational leaders. You'll help ensure appropriate level-of-care determinations, regulatory compliance, and reimbursement optimization while guiding your team through ongoing change and growth initiatives.
What You'll Do
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.
What You'll Bring
Required
Associate degree in Nursing or Health Information Management with RHIT certification.
Active Registered Nurse (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.
Preferred
Bachelor's degree in Nursing or Health Information Management with RHIA certification.
Three or more years of supervisory or leadership experience.
Case Management certification (ACM or CMSA).
Experience leading process improvement, workflow optimization, or change management initiatives.
Ideal Candidate Profile
We're seeking an experienced healthcare leader who thrives in a dynamic, highly collaborative environment and brings:
Deep expertise in Utilization Management and medical necessity review.
Proven success leading teams through change and transformation initiatives.
Strong communication and relationship-building skills with physicians, clinicians, and operational leaders.
The ability to balance regulatory, financial, and patient-centered priorities.
A forward-thinking mindset and enthusiasm for innovation, technology, and AI-enabled solutions.
Strong critical thinking, decision-making, and problem-solving abilities.
A collaborative leadership style focused on engagement, accountability, and continuous improvement.
What You'll Get
Opportunity to lead a highly specialized team responsible for critical organizational and patient care outcomes.
Meaningful involvement in workflow redesign, innovation initiatives, and future-state Utilization Management practices.
A supportive leadership environment that values professional growth and development.
Comprehensive benefits package and competitive retirement program.
Join Us
If you're an experienced Utilization Management leader who is energized by operational excellence, innovation, and leading teams through meaningful change, we'd love to hear from you.
Apply today and help shape the future of Utilization Management at Emplify Health.
