Remote Utilization Management RN - Path to CM Growth

WPS Health Solutions; Charlotte (NC); Teletrabalho; USD 75 000 - 100 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Remote and hybrid work options

Performance bonus

401(k) with generous match

Paid time off

Health and dental insurance

Telehealth services

Professional development programs

Resumo da oferta

WPS Health Solutions is seeking a Utilization Management RN to evaluate medical necessity and approve appropriate services for our Health Plan. The role includes cross-training potential into Case Management with future growth into CM and a broader UM/CM path.

The position offers remote work in approved states, with a start date of 01/10/2027 and a salary range of $75,000 to $100,000. The base pay may vary by knowledge, skills, and experience.

Qualificações

• RN with current licensure (Wisconsin) and 4+ years in varied clinical settings.
• 2+ years in Managed Care (prior authorization/utilization review) preferred within a commercial health plan.
• Experience coordinating care and case management for members.

Responsabilidades

• Evaluate medical necessity and authorize services per evidence-based criteria.
• Refer questionable cases to Medical Directors to prevent unnecessary procedures.
• Collaborate with Medical Directors and Health Services teams to improve processes and outcomes.
• Document case summaries and monitor Utilization Management queue to meet productivity standards.

Conhecimentos

Clinical review

Medical coding

Analytical thinking

Communication

Formação académica

BSN

CCM certification

CM in health plan

Ferramentas

Microsoft Office

EMR systems

Descrição da oferta de emprego

WPS Health Solutions is seeking a Utilization Management RN to evaluate medical necessity and approve appropriate services for our Health Plan. The role includes cross-training potential into Case Management with future growth into CM and a broader UM/CM path.

The position offers remote work in approved states, with a start date of 01/10/2027 and a salary range of $75,000 to $100,000. The base pay may vary by knowledge, skills, and experience.