Remote UM RN with CM Growth Path

WPS—A health solutions company; North Carolina; 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 for first 3%

Competitive paid time off

Health insurance and telehealth start

Professional and LeadershipDevelopment

Résumé du poste

WPS—A health solutions company is seeking a Utilization Management Registered Nurse to evaluate medical necessity and ensure appropriate services for our Health Plan. The UM RN will refer cases to medical directors when criteria are not met and may cross-train in Case Management for future growth.

The role supports remote work within approved states, with a base salary range noted and a start date of 01/10/2027, offering opportunities to expand responsibilities and impact on medical loss ratio.

Qualifications

• Demonstrated ability to work independently and manage a case load.
• Strong analytical, critical thinking and decision-making skills.
• Excellent communication and interpersonal skills with diverse teams.

Responsabilités

• Evaluate efficiency, appropriateness and medical necessity of services using evidence-based criteria.
• Refer questionable cases to medical directors to prevent unnecessary procedures or prolonged hospital stays.
• Cross-train in Case Management with potential growth into CM or UM/CM roles in the future.
• Collaborate with Health Services, Sales, Member Services, Claims, Provider Contracting and Billing & Enrollment to support optimal care.

Connaissances

Independent work

Analytical skills

Communication skills

Prioritization

Problem-solving

Decision-making

Formation

BSN

CCM certification

Outils

Microsoft Office

EMR systems

Description du poste

WPS—A health solutions company is seeking a Utilization Management Registered Nurse to evaluate medical necessity and ensure appropriate services for our Health Plan. The UM RN will refer cases to medical directors when criteria are not met and may cross-train in Case Management for future growth.

The role supports remote work within approved states, with a base salary range noted and a start date of 01/10/2027, offering opportunities to expand responsibilities and impact on medical loss ratio.