Remote Utilization Management RN — Path to CM Growth

WPS—A health solutions company; Michigan; A distancia; USD 75.000 - 100.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote and hybrid work options

Performance bonus

401(k) with employer match

Paid time off

Health insurance

Telehealth services

Professional development

Careers page benefits

Descripción de la vacante

WPS, a health solutions company, seeks an Utilization Management RN to evaluate medical necessity and authorize services for our Health Plan. You will refer questionable cases to medical directors to prevent unnecessary procedures and extended hospital stays.

Cross-training in Case Management offers growth toward a combined UM/CM role in the future. Start date is 01/10/2027 with a salary range of $75,000 to $100,000.

Formación

• RN with current licensure in the state of Wisconsin.

Responsabilidades

• Evaluate medical services for medical necessity and appropriateness using evidence-based criteria.
• Refer questionable cases to medical directors to prevent unnecessary procedures or prolonged hospital stays.
• Cross-train in Case Management with potential growth into a combined UM/CM role.
• Review and document case summaries and coordinate with Health Services and Medical Directors.

Conocimientos

RN licensure

Managed Care

Prior Authorization

Analytical skills

Communication skills

Microsoft Office

Educación

BSN preferred

CCM certification

Herramientas

EMR systems

Healthcare software

Descripción del empleo

WPS, a health solutions company, seeks an Utilization Management RN to evaluate medical necessity and authorize services for our Health Plan. You will refer questionable cases to medical directors to prevent unnecessary procedures and extended hospital stays.

Cross-training in Case Management offers growth toward a combined UM/CM role in the future. Start date is 01/10/2027 with a salary range of $75,000 to $100,000.