Remote Utilization Management RN — Growth Path to CM

WPS—A health solutions company; Minnesota; A distancia; USD 75.000 - 100.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote and hybrid work options

Performance bonus

401(k) with match

Health insurance

Dental insurance and telehealth

Professional development

Careers page review

Descripción de la vacante

WPS, a health solutions company, seeks an Utilization Management RN to evaluate medical necessity and authorize services for our Health Plan. The role involves cross-training in Case Management with potential growth into a combined UM/CM position or CM in the future.

Start Date: 01/10/2027. Remote work options available in a defined set of states including Minnesota. Salary range: $75,000–$100,000 with base pay variation based on experience.

Formación

• RN licensed in Wisconsin.
• 4+ years of RN experience in varied clinical settings.
• 2+ years in Managed Care / prior authorization.
• Experience coordinating care for case-managed members.
• Familiarity with health plan operations and payer relationships.
• Proficiency in MS Office and healthcare software.

Responsabilidades

• Evaluate medical necessity using evidence-based criteria.
• Authorize appropriate services; refer cases not meeting criteria to Medical Directors.
• Collaborate with Medical Directors and Health Services teams to optimize MLR and care quality.
• Document case summaries and refer non-compliant cases for escalation.
• Cross-train in Case Management with potential growth into UM/CM roles.
• Monitor Utilization Management queue and meet productivity targets.

Conocimientos

Analytical skills

Communication skills

Independence / time management

Microsoft Office proficiency

Educación

RN licensure (WI)

BSN (preferred)

CCM / CM experience (preferred)

URAC knowledge (preferred)

CMCN (preferred)

Herramientas

EMR systems

Descripción del empleo

WPS, a health solutions company, seeks an Utilization Management RN to evaluate medical necessity and authorize services for our Health Plan. The role involves cross-training in Case Management with potential growth into a combined UM/CM position or CM in the future.

Start Date: 01/10/2027. Remote work options available in a defined set of states including Minnesota. Salary range: $75,000–$100,000 with base pay variation based on experience.