Remote Utilization Management RN — Path to Case Management

WPS Health Solutions; Green Bay (WI); Teletrabalho; USD 75 000 - 100 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Remote work options

Performance bonus

401(k) with match

Paid time off

Health insurance

Telehealth services

Resumo da oferta

WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and authorize services for our Health Plan. The role may cross-train in Case Management with potential growth into a combined UM/CM position or CM in the future.

The position offers remote work options across approved states and a strong benefits package, with salary in the $75,000–$100,000 range depending on experience.

Qualificações

• Registered Nurse with current licensure in Wisconsin.
• 4+ years RN experience in varied clinical settings.
• 2+ years of Managed Care experience, preferably within a commercial health plan.
• Experience coordinating care for case managed members.
• Strong knowledge of medical practices, coding, and trends.
• Familiarity with health plan operations, payer/provider relationships, and insurance benefits.

Responsabilidades

• Evaluate efficiency, appropriateness, and medical necessity of medical services.
• Authorize services based on evidence-based criteria.
• Refer questionable cases to medical directors to prevent unnecessary procedures.
• Support cross-training in Case Management with growth toward UM/CM roles.
• Collaborate with Medical Directors and Health Services teams to optimize care and cost.

Conhecimentos

RN licensure (WI)

4+ years RN experience

Managed Care experience

Care coordination

Communication skills

Microsoft Office / healthcare software

Formação académica

BSN preferred

Ferramentas

EMR systems

Microsoft Office

Descrição da oferta de emprego

WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and authorize services for our Health Plan. The role may cross-train in Case Management with potential growth into a combined UM/CM position or CM in the future.

The position offers remote work options across approved states and a strong benefits package, with salary in the $75,000–$100,000 range depending on experience.