Jobs in the United States

25+ jobs

Added just now
General Manager
Mario Purchaser LLC
Sanford, FL
The General Manager is responsible for providing overall leadership to Len the Plumber Heating & Air to achieve company revenue, profitability and KPI objectives while creating a customer…
Added just now
Branch Manager
Johnstone Supply LLC
NORTH CHARLESTON, SC
Ensures the safety of the workforce by clearly communicating and supporting the company’s safety programs and specific safety initiatives to all levels of personnel and management; observes…
Added 1 min ago
Operations Manager
ALAMANCE FOODS INC
Burlington, NC
The Operations Manager is responsible for overseeing all aspects of production, maintenance, quality, and supply chain activities within the aerosol food manufacturing facility. This role…
Added 1 min ago
RH
HR Manager
Robert Half
Encinitas, CA
- $55 to $57 USD / hour
A coastal public agency is seeking a strategic HR Manager to guide personnel programs, strengthen employee relations, and support department leadership across a complex public-sector…
Added 2 mins ago
Boilermaker Superintendent
Black & Veatch Family of Companies
Cartersville, GA
…technical data and information, as required, to direct hire workforce, subcontractor supervision or Construction Engineers. Ensures compliance by workforce or subcontractor to all…
Added 2 mins ago
Director, HR Technology and Workforce Analytic
Columbus McKinnon Corporation
Charlotte, NC
…hands-on problem solving. This role will improve employee and manager experience, operational efficiency, risk management, workforce decision-making, and the company's ability to support…
Added 2 mins ago
ASSOCTIATE DIRECTOR, NUTRITION
The D C Central Kitchen Inc
Washington, DC
The Food Access and Nutrition department is responsible for all aspects of DC Central Kitchen’s Food Access programs, services, and activities, including but not limited to menu planning,…
Added 3 mins ago
GO
Deputy Director, California Education Interagency Council (CEIC)
Government Operations Agency
CA
- $10,349 to $12,526 USD / month
2. Provide your experience navigating the legislative and budget process and implementing federal and state funding programs for education and/or workforce. In your response, include…
Added 3 mins ago
TC
Manager, Talent Acquisition - Workforce Development
The Children's Hospital of Philadelphia
United States
- $117,900 to $156,300 USD / year
…categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in…
Added 4 mins ago
E
Reading Instructor
Equus
Dayton, OH
- $42,697.2 to $47,720.4 USD / year
…high-growth, high-demand industries. Our committed and well-trained workforce professionals deliver comprehensive workforce solutions at integrated career centers, sector-focused centers…
Added 5 mins ago
26026084 Enablement Program (Content Mgmt Systems) Marketing Manager
Bank of America, National Association
United States
…foster resilience, leadership and innovation, strengthening our workforce and positively impact the communities we serve. Bank of America is committed to an in-office culture that supports…
Added 5 mins ago
Academy Manager - Consumer Retail and Preferred Servicing
Bank of America, National Association
United States
Facilitates onboarding, core and/or upskill Academy programs (virtually and/or in the classroom), inclusive of delivering program content, assessments, managing practice pods, call…
Added 6 mins ago
Warehouse Operations Manager
Spreetail
Nanticoke, PA
…to confirm that your state qualifies for the Work Your Way…
Added 7 mins ago
Senior Program Manager – IT & Application Service Desk
Integral
Tysons Corner, VA
Integral Federal is seeking a Senior Program Manager to lead an enterprise service desk and mission-critical contact center program for a prominent federal agency. Operating in a…
Added 7 mins ago
Production Manager
Cintas
Amarillo, TX
Communication - Collaborates with General Manager and all other department leaders to ensure the production team is working toward shared location goals and achieving key performance…
Added 8 mins ago
Problem Analyst
WGU Corporation
Salt Lake City, UT
Driven by a mission to expand access to higher education through online, competency-based degree programs, WGU is also committed to being a great place to work for a diverse workforce of…
Added 9 mins ago
Manager, Account Management
PowerSchool Group LLC
Dallas, TX
The Inside Sales Manager leads and develops a team of Inside Sales Hunters responsible for new logo acquisition across high-velocity territories. They drive team-level pipeline generation,…
Added 9 mins ago
Call Center Manager
Merchants Bank of Indiana
Carmel, IN
The Call Center Manager monitors service levels, workforce performance, quality standards, and operational metrics to ensure consistent delivery of accurate and client-centric support…
Added 10 mins ago
Cryogenic Systems Engineering Manager
LLNL
Livermore, CA
We have an opening for a Cryogenic Systems Engineering Manager to lead and advance the cryogenic operations and engineering capabilities that support the successful fielding of all NIF…
Added 10 mins ago
UC
Public Assistance Case Manager
Union County Ohio
Marysville, OH
- $20.62 to $27.72 USD / hour
Conducts initial interviews and/or assessments of clients for a variety of workforce development programs and seeks to resolve barriers to employment.
Added 12 mins ago
MC
Sr Manager, Compensation Strategy
McDonald's Corporation
Chicago, IL
- $156,495 to $195,618 USD / year
…portion of time devoted to solving complex compensation and workforce questions rather than ongoing program administration. The Senior Manager will use compensation expertise as a…
Added 15 mins ago
Senior Executive
Matrix Research, Inc.
Beavercreek, OH
…continue the company's current growth trajectory. Experience as a Program/Project manager, executive, or site lead with 20 - 25 years of experience required. Candidate must be a US citizen…
Added 16 mins ago
HR Specialist, Talent Programs & Outreach
World Bank Group
Washington, DC
…recruitment for WBG Explorers, WBG Global Fellowship, other talent programs and outreach activities, with a strong focus on design, implementation, candidate/staff experience, tracking and…
Added 17 mins ago
Production Assistant
University System of Georgia
GA
…through broadening access to high-quality education and advancing workforce development. Clayton State offers multiple certificates, Associate's, Bachelor's, and Master's Degree programs,…
Added 17 mins ago
Apprenticeship Program Coordinator
Walker White Mechanical
Columbia, SC
As the Apprenticeship Program Coordinator, you'll serve as the driving force behind the success of Walker White Mechanical's apprenticeship and workforce development programs.

Utilization Management RN

Remote, United States

Start Date: 01/10/2027 Salary Range: $75,000 ~ $100,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

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Job details

Pay: Start Date: 01/10/2027 Salary Range: $75,000 ~ $100,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.
Posting language: English
Posted: Nov 3, 2026

Original job description

Our Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness, and medical necessity for medical services, and procedures for our Health Plan. This role uses clinical knowledge to provide judgment to review medical services with evidence-based criteria, authorize requested services as appropriate. Our Utilization Management RN will be responsible for referring questionable cases to medical directors to prevent unnecessary procedures, treatments, or prolonged hospital stays. We’re looking for someone who’s open to cross-training in Case Management (CM), with the potential for the role to grow into a combined UM/CM position or transition into CM in the future.

Start Date: 01/10/2027 Salary Range: $75,000 ~ $100,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

Work Location

We are open to remote work in the following approved states:

Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin

How do I know this opportunity is right for me? If you:

Enjoy working with healthcare professionals to facilitate appropriate and quality services in a cost-effective manner to positively impact medical loss ratio.
Can work closely with Medical Directors to facilitate decision-making process for the Health Services department.
Have experience reviewing medical and behavioral health prior authorization requests for medical necessity and appropriateness of requested treatment according to medical policies and evidence-based criteria.
Have experience working closely with members of Health Services, and key contacts in Sales, Member Services, Claims, Provider Contracting, and Billing & Enrollment.
Can document case summaries and refer cases to Medical Director that do not meet internal or external guidelines, policies, or medical criteria.
Like to be accountable to monitor and maintain inventory in the Utilization Management queue to meet productivity standards.
Enjoy evaluating, analyzing, and reporting trends in utilization changes in all healthcare delivery areas.
Can make recommendations and implement changes consistent with Health Services objectives of quality care and reasonable cost.
Would enjoy identifying opportunities and provide recommendations to improve department processes.
Have Identified legal or liability issues and refer potential ethical or risk management issues to the appropriate department for resolution.
Have participated in training new nursing staff on department workflows, policies, and procedures.
Can work cross functionally to support other departmental efforts to ensure overall efficiency, quality, productivity, and compliance with all departmental, regulatory and URAC standards.

Minimum Qualifications

Registered Nurse (RN) with current licensure in the state of Wisconsin.
4 or more years of experience as a Registered Nurse in varied clinical settings (i.e., hospital, clinic, home care, skilled nursing facility, etc.).
2 or more years of experience in Managed Care (i.e., prior authorization, utilization review), preferably within a commercial health plan.
Demonstrated experience managing and coordinating care effectively for case managed members.
Strong knowledge of current medical practices, medical coding, trends and patterns of care.
Familiarity with health plan operations, payer/provider relationships, and insurance benefits.
Strong diverse experience and expertise that includes:
The ability to work independently, manage a case load, and prioritization.
Excellent analytical, critical thinking, problem-solving skills and decision-making skills.
Excellent communication and interpersonal skills to work with members, providers, and teams
Proficiency in Microsoft Office and healthcare software and systems.

Preferred Qualifications

Bachelor’s degree in nursing (BSN).
Certified Case Manager (CCM) and prior experience in Case Management (CM) within a health plan.
Background in commercial health insurance, including Point of Service (POS) or Preferred Provider Organization (PPO) plans.
Knowledge of Utilization Review Accreditation Commission (URAC).
Certified Managed Care Nurse (CMCN).
Technical experience with word processing, spreadsheets, and proficiency with electronic medical record (EMR) systems and/or other managed care software.

Remote Work Requirements

High speed cable or fiber internet
Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
Please review Remote Worker FAQs for additional information

Benefits

Remote and hybrid work options available
Performance bonus and/or merit increase opportunities
401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
Competitive paid time off
Health insurance, dental insurance, and telehealth services start DAY 1
Professional and Leadership Development Programs
Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS’ culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce - both current and future - to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.

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