Manager | Utilization Management Services

Scheduled Weekly Hours:

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 youll 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 youll provide leadership to a team of approximately 20 professionals while partnering closely with physicians medical directors and operational leaders. Youll help ensure appropriate level-of-care determinations regulatory compliance and reimbursement optimization while guiding your team through ongoing change and growth initiatives.

What Youll 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 Youll Bring

Required

• Associate degree in Nursing or Health Information Management with RHIT certification.
• Registered Nurses without a bachelors degree must obtain a Bachelor of Science in Nursing (BSN) within six years of hire.
• Associate degree holders must obtain a bachelors 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

• Bachelors 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

Were 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 Youll 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 Michigans Upper Peninsula. Join us in making a meaningful difference in the lives of our patients and communities.

Join Us

If youre an experienced Utilization Management leader who is energized by operational excellence innovation and leading teams through meaningful change wed 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 or call .

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