Remote Utilization Management RN — UM/CM Career Path

WPS Health Solutions; Atlanta (GA); A distancia; USD 75.000 - 100.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote/Hybrid work options

Performance bonus

401(k) with match

Health insurance

Paid time off

Professional development

Descripción de la vacante

WPS Health Solutions is seeking an Utilization Management RN to evaluate medical services for appropriateness and necessity using evidence-based criteria. The role involves authorizing services, referring cases to medical directors, and potential cross-training in Case Management with growth into a combined UM/CM position.

The position is remote with approved states including GA; starts 01/10/2027 and offers a salary range of $75,000 to $100,000 with base pay varying by knowledge and experience.

Formación

• RN with current licensure in Wisconsin.
• 4+ years RN experience in varied clinical settings.
• 2+ years in Managed Care, preferably within a commercial health plan.
• Familiarity with health plan operations, payer/provider relationships, and insurance benefits.

Responsabilidades

• Review medical services for medical necessity and appropriateness.
• Authorize requested services as appropriate.
• Refer questionable cases to medical directors to prevent unnecessary procedures.
• Cross-training in Case Management with potential growth into UM/CM roles.

Conocimientos

RN licensure (WI)

Educación

BSN (preferred)

Descripción del empleo

WPS Health Solutions is seeking an Utilization Management RN to evaluate medical services for appropriateness and necessity using evidence-based criteria. The role involves authorizing services, referring cases to medical directors, and potential cross-training in Case Management with growth into a combined UM/CM position.

The position is remote with approved states including GA; starts 01/10/2027 and offers a salary range of $75,000 to $100,000 with base pay varying by knowledge and experience.