Remote Utilization Management RN: Path to CM Growth

WPS Health Solutions; Detroit (MI); Teletrabalho; USD 75 000 - 100 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Remote and hybrid options

Performance bonus

401(k) matching

Resumo da oferta

WPS Health Solutions is seeking a Utilization Management Registered Nurse to evaluate medical necessity and appropriateness of services for our Health Plan, applying evidence-based criteria to authorize care and referring cases when needed. The role includes cross-training in Case Management and potential growth into a combined UM/CM position.

The position offers remote work in approved states, a salary range of $75,000–$100,000, and benefits.

Qualificações

• RN with current licensure 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.
• Knowledge of current medical practices and coding.
• Familiarity with health plan operations and payer/provider relationships.

Responsabilidades

• Review medical necessity and appropriateness of services using evidence-based criteria.
• Authorize requested services when appropriate and refer questionable cases to Medical Directors.
• Refer potential ethical or risk issues to the appropriate department and document case summaries.
• Support cross-training in Case Management and potential growth to UM/CM roles.

Conhecimentos

RN experience

Managed Care

Case management

Healthcare policy

Analytical skills

Communication skills

Formação académica

BSN

Ferramentas

EMR systems

Microsoft Office

Descrição da oferta de emprego

WPS Health Solutions is seeking a Utilization Management Registered Nurse to evaluate medical necessity and appropriateness of services for our Health Plan, applying evidence-based criteria to authorize care and referring cases when needed. The role includes cross-training in Case Management and potential growth into a combined UM/CM position.

The position offers remote work in approved states, a salary range of $75,000–$100,000, and benefits.