Remote Utilization Management RN—Path to Case Management

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

Ventajas ofrecidas por este puesto de trabajo

Performance bonus and merit increases

401(k) match

Competitive PTO

Health, dental, and telehealth fromDay

Professional and LeadershipDevelopment

Careers website

Descripción de la vacante

WPS—A health solutions company is seeking a Registered Nurse for Utilization Management to evaluate medical necessity and appropriateness of services. The role may cross-train into Case Management and grow into a combined UM/CM position with potential future advancement.

Remote work is available for qualified states, including FL. The position starts 01/10/2027 with a base pay range of $75,000 to $100,000, varying by experience and knowledge.

Formación

• RN licensed in Wisconsin
• 4+ years RN experience in varied clinical settings
• 2+ years in Managed Care (prior authorization, utilization review)
• Experience coordinating care for case-managed members
• Strong knowledge of medical practices, coding, and care patterns
• Familiarity with health plan operations and insurance benefits
• Ability to work independently, manage caseload, and prioritize
• Excellent analytical, problem-solving, and communication skills

Responsabilidades

• Evaluate efficiency, appropriateness, and medical necessity for services.
• Refer questionable cases to medical directors for review.
• Cross-train in Case Management with potential growth into UM/CM.
• Monitor and maintain Utilization Management queue to meet productivity.
• Collaborate with Medical Directors and Health Services teams.
• Document case summaries and refer cases not meeting guidelines to Medical Director.

Conocimientos

Analytical thinking

Communication skills

Problem-solving

Independent work

Prioritization

Educación

Bachelors degree in nursing (BSN)

Certified Case Manager (CCM)

Herramientas

Microsoft Office

EMR systems

Descripción del empleo

WPS—A health solutions company is seeking a Registered Nurse for Utilization Management to evaluate medical necessity and appropriateness of services. The role may cross-train into Case Management and grow into a combined UM/CM position with potential future advancement.

Remote work is available for qualified states, including FL. The position starts 01/10/2027 with a base pay range of $75,000 to $100,000, varying by experience and knowledge.