Manager | Utilization Management Services

Love + medicine is who we are, it's what we do, it's why people want to work here. If you're looking for a job to love, apply today.

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.
• Registered Nurses without a bachelor's degree must obtain a Bachelor of Science in Nursing (BSN) within six years of hire.
• Associate degree holders must obtain a bachelor's degree in a healthcare-related field within six years of hire.
• Two to three years of Utilization Management experience.
• One of the following: Active Registered Nurse (RN) license in the state of practice (additional state licenses may be required for some positions), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA)

Preferred

• Bachelor's degree in Nursing or Health Information Management with RHIA certification.
• Three years of Utilization Management experience with previous 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.

About Emplify Health

Emplify Health, a partnership of Bellin Health and Gundersen Health System, is a leading not-for-profit, patient-centered healthcare network based in Green Bay and La Crosse, Wisconsin. With 11 hospitals and over 100 clinics, we serve communities across Wisconsin, Iowa, Minnesota, and Michigan's Upper Peninsula. Join us in making a meaningful difference in the lives of our patients and communities.

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.

Equal Opportunity Employer

If you need assistance with any portion of the application or have questions about the position, please contact HR-Recruitment@gundersenhealth.org or call 608-775-0267.

We inspire your best life by relentlessly caring, learning and innovating. This is our purpose. Together with our values - belonging, respect, excellence, accountability, teamwork and humility - our pillars set our foundation and our future.

Equal Opportunity Employer