Remote UM RN - Growth toward Case Management

WPS Health Solutions; Columbus (OH); À distance; USD 75 000 - 100 000; Plein temps

Avantages offerts par ce poste

Remote and hybrid work options

Performance bonus

401(k) with 100% match up to 3%

Health and dental insurance

Paid time off

Professional development

Résumé du poste

WPS Health Solutions seeks an Utilization Management RN to evaluate medical necessity and ensure appropriate services under our Health Plan. The role applies evidence-based criteria and coordinates with medical directors to prevent unnecessary procedures.

The position offers remote work options in approved states, a start date of 01/10/2027, and a salary range of $75,000–$100,000 with competitive benefits. It includes opportunities to cross-train in Case Management and grow toward CM leadership.

Qualifications

• RN licensed in Wisconsin.
• 4+ years RN experience across clinical settings.
• 2+ years managed care experience, preferably in a commercial health plan.
• Experience coordinating care for case-managed members.
• Strong knowledge of medical practices, coding, and care trends.
• Familiarity with health plan operations, payer/provider relationships, and benefits.
• Able to work independently, manage a caseload, and prioritize.
• Excellent analytical, critical thinking, and decision-making skills.
• Strong communication and interpersonal skills.
• Proficiency in Microsoft Office and healthcare software.

Responsabilités

• Evaluate efficiency, appropriateness, and medical necessity for services.
• Refer cases not meeting criteria to Medical Directors.
• Open to cross-training in Case Management with potential growth to UM/CM.
• Collaborate with Medical Directors and Health Services teams to support decisions.

Connaissances

RN licensure

Case management coordination

Analytical thinking

Communication skills

Microsoft Office proficiency

Formation

BSN preferred

CCM certification

Outils

EMR systems

Microsoft Office

Description du poste

WPS Health Solutions seeks an Utilization Management RN to evaluate medical necessity and ensure appropriate services under our Health Plan. The role applies evidence-based criteria and coordinates with medical directors to prevent unnecessary procedures.

The position offers remote work options in approved states, a start date of 01/10/2027, and a salary range of $75,000–$100,000 with competitive benefits. It includes opportunities to cross-train in Case Management and grow toward CM leadership.