Remote Utilization Management RN - Path to CM Growth

WPS Health Solutions; Des Moines (IA); A distancia; USD 75.000 - 100.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote/hybrid options

Performance bonus

401(k) match

Paid time off

Health insurance

Descripción de la vacante

WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and appropriate services for our Health Plan. The role includes cross-training in Case Management with potential growth into CM in the future.

The position offers remote work options with a competitive salary range and is open to candidates in multiple states. Prior authorization and utilization review experience are preferred for this role.

Formación

• RN with current WI licensure.
• 4+ years RN in varied clinical settings.
• 2+ years in Managed Care, preferably in a commercial plan.
• Experience coordinating care for case-managed members.
• Familiarity with health plan operations and payer relationships.

Responsabilidades

• Evaluate efficiency, appropriateness, and medical necessity of services.
• Refer questionable cases to medical directors to prevent unnecessary procedures.
• Cross-train in Case Management with potential for UM/CM growth.
• Monitor Utilization Management queue to meet productivity standards.
• Collaborate with Medical Directors and other departments to ensure quality care.

Conocimientos

RN experience

Managed care know-how

Analytical skills

Communication skills

MS Office

Educación

BSN preferred

CCM certification

CM in health plan

Herramientas

EMR systems

Healthcare software

Descripción del empleo

WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and appropriate services for our Health Plan. The role includes cross-training in Case Management with potential growth into CM in the future.

The position offers remote work options with a competitive salary range and is open to candidates in multiple states. Prior authorization and utilization review experience are preferred for this role.