Remote Utilization Management RN — Path to UM/CM Growth

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

Ventajas ofrecidas por este puesto de trabajo

Remote and hybrid work options

Performance bonus/merit increase

401(k) with 100% match up to 3% and 50

Paid time off

Health and dental insurance + teleheh"

Descripción de la vacante

WPS—A health solutions company is seeking an experienced Utilization Management RN to evaluate the necessity and appropriateness of medical services, authorizing needed care and collaborating with medical directors. The role offers remote work with quotas and potential growth into CM.

Start date is 01/10/2027 and salary ranges from $75,000 to $100,000 annually. Ideal candidates will be a Wisconsin-licensed RN with 4+ years in varied clinical settings and 2+ years in managed care, including prior

Formación

• RN with Wisconsin license and 4+ years clinical RN experience.
• 2+ years in Managed Care, preferably within a commercial health plan.
• Experience reviewing prior authorization requests for medical necessity per policies.
• Coordinate care and manage caseload independently and efficiently.
• Strong knowledge of medical practices, coding, payer relations, and health plan operations.
• Proficiency with Microsoft Office and EMR systems.

Responsabilidades

• Review medical necessity and prior authorization requests using evidence-based criteria.
• Refer questionable cases to Medical Directors to prevent unnecessary procedures.
• Document case summaries and refer cases not meeting guidelines to Medical Directors.
• Monitor utilization queue and maintain productivity targets.
• Collaborate with Health Services, Sales, Claims and Billing teams to support care decisions.

Conocimientos

RN licensure

RN experience

Managed care experience

Care coordination

Analytical thinking

Communication skills

EMR & healthcare software

Educación

BSN preferred

CCM certification

Herramientas

EMR systems

Healthcare software

Descripción del empleo

WPS—A health solutions company is seeking an experienced Utilization Management RN to evaluate the necessity and appropriateness of medical services, authorizing needed care and collaborating with medical directors. The role offers remote work with quotas and potential growth into CM.

Start date is 01/10/2027 and salary ranges from $75,000 to $100,000 annually. Ideal candidates will be a Wisconsin-licensed RN with 4+ years in varied clinical settings and 2+ years in managed care, including prior