Remote Utilization Management RN — Path to UM/CM Growth

WPS—A health solutions company; Illinois; 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 employer match

Paid time off

Health, dental, and telehealth start 1

Professional development programs

Resumo da oferta

WPS, a health solutions company, is hiring an Utilization Management RN to evaluate medical necessity and appropriateness of services. You will collaborate with Medical Directors to support decision-making and may cross-train for Case Management, with potential growth into a combined UM/CM role.

The position supports remote work in approved states across the U.S., including Illinois, with a start date of 01/10/2027. A strong background in managed care and nursing practice is essential.

Qualificações

• Registered Nurse (RN) with current licensure in Wisconsin.
• 4+ years of 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, coding, and trends.
• Familiarity with health plan operations and provider relations.
• Independence in caseload management and strong analytical skills.
• Proficiency in Microsoft Office and healthcare software.

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.
• Document case summaries and refer non-conforming cases to Medical Director.
• Monitor utilization queue to meet productivity standards.
• Identify trends and report on utilization changes in healthcare delivery.

Conhecimentos

RN clinical experience

Managed care experience

Analytical thinking

Communication skills

Problem solving

MS Office proficiency

EMR proficiency

Formação académica

BSN (preferred)

CCM certification (preferred)

URAC knowledge (preferred)

Ferramentas

EMR systems

Healthcare software

Descrição da oferta de emprego

WPS, a health solutions company, is hiring an Utilization Management RN to evaluate medical necessity and appropriateness of services. You will collaborate with Medical Directors to support decision-making and may cross-train for Case Management, with potential growth into a combined UM/CM role.

The position supports remote work in approved states across the U.S., including Illinois, with a start date of 01/10/2027. A strong background in managed care and nursing practice is essential.