Remote Utilization Management RN: Growth toward CM

WPS Health Solutions; Minneapolis (MN); 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 matching

Competitive paid time off

Health and dental insurance

Telehealth services start DAY 1

Professional and LeadershipDevelopment

Descripción de la vacante

WPS Health Solutions in Minnesota is seeking a Utilization Management RN to evaluate efficiency, appropriateness, and medical necessity for services under our Health Plan. The role uses clinical knowledge to review requests and authorize care when appropriate.

This position offers remote work options with potential to cross-train in Case Management and grow into a combined UM/CM role or CM in the future. Start date is 01/10/2027.

Formación

• RN with Wisconsin licensure and 4+ years varied clinical experience.
• 2+ years in Managed Care, 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 and insurance benefits.
• Independent work style with strong analytical and communication skills.
• Proficiency in Microsoft Office and healthcare software.

Responsabilidades

• Evaluate medical services for necessity using evidence-based criteria and authorize appropriate services.
• Refer questionable cases to medical directors to prevent unnecessary procedures.
• Cross-train in Case Management with potential UM/CM growth.
• Collaborate with Medical Directors and Health Services teams on decisions.
• Monitor Utilization Management queue to meet productivity standards.

Conocimientos

RN experience

Managed Care

Care coordination

Medical terminology

Microsoft Office

Evidence-based criteria

Educación

Bachelor's degree in nursing

Herramientas

EMR systems

Descripción del empleo

WPS Health Solutions in Minnesota is seeking a Utilization Management RN to evaluate efficiency, appropriateness, and medical necessity for services under our Health Plan. The role uses clinical knowledge to review requests and authorize care when appropriate.

This position offers remote work options with potential to cross-train in Case Management and grow into a combined UM/CM role or CM in the future. Start date is 01/10/2027.