Remote Utilization Management RN - Path to CM Growth

WPS Health Solutions; Indianapolis (IN); A distancia; USD 75.000 - 100.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work options

Performance bonus

401(k) matching

Paid time off

Health insurance

Descripción de la vacante

WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and authorize services in coordination with medical directors. This role emphasizes evidence-based decision-making, case reviews, and referral when criteria aren’t met.

There is open potential for cross-training in Case Management and for progression into a combined UM/CM position in the future, with a start date of 01/10/2027 and a salary range of $75,000–$100,000.

Formación

• RN licensure in Wisconsin is required.
• 4+ years of RN experience across varied clinical settings.
• 2+ years in Managed Care (prior authorization, utilization review), preferably in a commercial health plan.
• Familiarity with URAC, healthcare payer relationships, and insurance benefits.

Responsabilidades

• Evaluate efficiency, appropriateness, and medical necessity for medical services.
• Refer questionable cases to medical directors to prevent unnecessary procedures.
• Cross-train in Case Management with potential for UM/CM progression.

Conocimientos

RN experience

Managed Care

Case management

Analytical skills

Communication skills

Independent work

Prioritization

Educación

RN licensure in Wisconsin

BSN (preferred)

Herramientas

Microsoft Office

EMR systems

Descripción del empleo

WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and authorize services in coordination with medical directors. This role emphasizes evidence-based decision-making, case reviews, and referral when criteria aren’t met.

There is open potential for cross-training in Case Management and for progression into a combined UM/CM position in the future, with a start date of 01/10/2027 and a salary range of $75,000–$100,000.