Remote Utilization Management RN—Growth to Case Management

WPS—A health solutions company; Iowa; Remote; USD 75,000 - 100,000; Full time

Benefits offered by this job

Remote and hybrid work options

Performance bonus

401(k) with a 100% match for the first

Health insurance starting DAY 1

Professional and LeadershipDevelopment

Job summary

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

Remote-friendly with growth opportunities, the role requires Wisconsin RN licensure and 4+ years in varied clinical settings, plus 2+ years in managed care and strong analytical, communication, and collaboration skills.

Qualifications

• RN with Wisconsin licensure and 4+ years in varied clinical settings.
• 2+ years in managed care, including prior authorization.
• Experience coordinating care and reviewing medical necessity.
• Strong analytical, communication, and problem-solving skills.

Responsibilities

• Evaluate medical services for necessity using evidence-based criteria.
• Refer cases to Medical Directors to prevent unnecessary procedures.
• Collaborate with Health Services, Sales, Claims, and Enrollment teams.
• Monitor utilization management queue to meet productivity standards.

Skills

RN license (WI)

Care coordination

Managed care experience

Medical policy knowledge

Analytical skills

Communication skills

Microsoft Office

EMR systems

Education

BSN degree

CCM certification

CM experience

URAC knowledge

Tools

EMR systems

Microsoft Office

Job description

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

Remote-friendly with growth opportunities, the role requires Wisconsin RN licensure and 4+ years in varied clinical settings, plus 2+ years in managed care and strong analytical, communication, and collaboration skills.