Remote Utilization Management RN Case Manager

Quartz Health Solutions; Wisconsin; Hybrid; USD 73,000 - 91,000; Full time

Benefits offered by this job

Supportive team and training

Salaried Monday - Friday, no weekends/

Growth opportunities

Hybrid or remote options

Travel within service area

Job summary

Quartz Health Solutions is seeking a licensed RN for a Utilization Management RN Case Manager role in Wisconsin. You will review prior authorization requests, coordinate transitions back to in-network services, and collaborate with physicians, hospital case managers, home health, and SNF staff to ensure optimal patient care.

This is a salaried Monday–Friday position with no weekends or holidays, offering growth opportunities.

Qualifications

• Bachelor’s or Associate degree in nursing with licensure in Wisconsin.
• Unrestricted Wisconsin RN license; Compact state license acceptable.
• 2+ years RN utilization management experience preferred.
• Insurance/managed care experience preferred; some travel required.
• Strong customer service and computer skills.

Responsibilities

• Perform clinical reviews of prior authorization requests.
• Conduct prospective, concurrent, and retrospective medical review for inpatient, SNF and home health services.
• Coordinate care plans and transitions of care.
• Communicate with members, caregivers and providers about reviews.
• Document information and present cases to Medical Director as needed.

Skills

Utilization management

Customer service

Communication skills

Word processing

Excel

UM decision support software

Education

Bachelor’s Degree in Nursing

Associate Degree in Nursing

Tools

UM decision support software

Microsoft Word

Microsoft Excel

Job description

Quartz Health Solutions is seeking a licensed RN for a Utilization Management RN Case Manager role in Wisconsin. You will review prior authorization requests, coordinate transitions back to in-network services, and collaborate with physicians, hospital case managers, home health, and SNF staff to ensure optimal patient care.

This is a salaried Monday–Friday position with no weekends or holidays, offering growth opportunities.