Remote UM RN: Path to Case Management Leadership

WPS Health Solutions; Houston (TX); À distance; USD 75 000 - 100 000; Plein temps

Avantages offerts par ce poste

Remote and hybrid work options

Performance bonus and merit increases

401(k) with 100% match up to 3% + 50%

Paid time off

Health/dental/telehealth from Day 1

Professional development

Know Your Rights resources

Résumé du poste

WPS Health Solutions in Madison, Wisconsin, seeks a Utilization Management RN to evaluate medical necessity for services, authorize appropriate care, and coordinate with medical directors. The role supports cross-training in Case Management and growth into a combined UM/CM position.

Start Date: 01/10/2027. Remote work option available in approved states including Texas and others, with a salary range of $75,000 to $100,000. Base pay varies by knowledge and experience.

Qualifications

• RN with current licensure (Wisconsin)
• 4+ years RN experience in varied clinical settings
• 2+ years managed care experience (preferably within 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
• Independence with caseload management, prioritization, and strong analytical skills
• Proficiency in MS Office and healthcare software/tools

Responsabilités

• Evaluate efficiency, appropriateness, and medical necessity for medical services.
• Authorize requested services as appropriate and refer questionable cases to medical directors.
• Cross-train in Case Management with potential growth to a combined UM/CM role.
• Monitor Utilization Management queue to meet productivity standards.
• Collaborate with Medical Directors and Health Services team on decision-making processes.

Connaissances

RN licensure

4+ years RN experience

Managed Care experience

Care coordination

Medical coding knowledge

MS Office/Healthcare software

Independent work

Analytical thinking

Formation

BSN

Certified Case Manager (CCM)

Certified Managed Care Nurse (CMCN)

URAC knowledge

Outils

EMR systems

Word processing

Spreadsheets

Description du poste

WPS Health Solutions in Madison, Wisconsin, seeks a Utilization Management RN to evaluate medical necessity for services, authorize appropriate care, and coordinate with medical directors. The role supports cross-training in Case Management and growth into a combined UM/CM position.

Start Date: 01/10/2027. Remote work option available in approved states including Texas and others, with a salary range of $75,000 to $100,000. Base pay varies by knowledge and experience.