Jobs in the United States

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Added 2 mins ago
Remote Search Consultant / Recruiter
GPAC
Washburn, ND
A background in business development, client relationships, marketing, or sales is preferred
Added 2 mins ago
Supply Planner
Conagra Brands
Omaha, NE
Number of Days in Office: 3
Added 2 mins ago
Property Accountant
CBRE
Omaha, NE
…clients through four business segments: Advisory (leasing, sales, debt origination, mortgage serving, valuations); Building Operations & Experience (facilities management, property…
Added 3 mins ago
EI
Inside Sales Representative
EBSCO Information Services
Lincoln, NE
- $56,335 to $80,475 USD / year
You will be welcomed as a member of our subscription services focused Inside Sales Team, working in all markets in an assigned territory. Our team enjoys the flexibility and greater work…
Added 4 mins ago
Director - Business Development
UHS
PORTSMOUTH, VA
The Director of Business Development oversees the provision of Sales, Marketing, and Customer Service activities within the Marketing Department. The Director of Business Development is…
Added 10 mins ago
Remote Search Consultant / Recruiter
GPAC
Onawa, IA
A background in business development, client relationships, marketing, or sales is preferred
Added 10 mins ago
Remote Search Consultant / Recruiter
GPAC
Superior, NE
A background in business development, client relationships, marketing, or sales is preferred
Added 11 mins ago
G
Water/Wastewater Engineer
GPAC
Atlanta, GA
- $90,000 to $150,000 USD / year
Credentials: MUST HAVE P.E
Added 13 mins ago
Supervisor, Field Services
Siplast
NY
…supervision of frontline field reps, trainings, claims resolution, sales support, and legal assistance, working with new product development teams, and technical assistance. This position…
Added 16 mins ago
Business Development Manager
Select Medical
Independence, MO
…working as a team within a market and region? Come join our sales team at Select Physical Therapy, a member of the Select Medical family, as a business development manager. In this role,…
Added 16 mins ago
District Manager - Wireless
Acosta Group
Columbia, MO
Premium Retail Services' wireless program spans more than 1,300 retail locations across North America and is powered by a dedicated team of over 3,200 Wireless Sales Pros.
Added 16 mins ago
Customer Experience Manager- EdTech
Accenture
St. Louis, MO
(If Associate Degree, must have minimum 6 years work experience)
Added 16 mins ago
Account Executive, Employer & Employer Coalitions - Express Scripts - Hybrid
The Cigna Group
St. Louis, MO
…consultants. This position is the owner of the strategic renewal plan, development of long term account strategy and leads the growth & retention of current clients. The Account Executive…
Added 16 mins ago
CG
SHIFT SUPERVISOR (FULL TIME)
Compass Group, North America
Saint Louis, MO
- $17 to $19 USD / hour
- Full-time
…our core values, work life balance, and ongoing training and development opportunities. This, along with our rapid growth, means accelerated promotion opportunities for every motivated…
Added 16 mins ago
CC
Digital Communications Automation Specialist
Centene Corporation
Jefferson City, MO
- $70,100 to $126,200 USD / year
Business Area: Business Development, Sales & Marketing
Added 16 mins ago
CC
Digital Communications Automation Specialist
Centene Corporation
Jefferson City, MO
- $70,100 to $126,200 USD / year
Business Area: Business Development, Sales & Marketing
Added 16 mins ago
EI
Inside Sales Representative
EBSCO Information Services
Jefferson City, MO
- $56,335 to $80,475 USD / year
You will be welcomed as a member of our subscription services focused Inside Sales Team, working in all markets in an assigned territory. Our team enjoys the flexibility and greater work…
Added 16 mins ago
Principal Sales Representative, CAS (Kansas City)
Medtronic
Kansas City, MO
The individual must reside within the territory and regularly travel to customer accounts, including hospitals, clinics, and procedural settings
Added 16 mins ago
MedTech Recall Specialist/Call Center- Remote Central Time Zone CST
IQVIA
Kansas City, MO · St Louis, MO
…technologies. This includes contract clinical, field technical, inside sales and recall support. Our flexible model enables us to deploy and manage teams that expand and contract to meet…
Added 20 mins ago
QI
Software Engineer (San Diego, Boulder)
Qualcomm Incorporate
Boulder, CO
- $109,400 to $164,200 USD / year
…Qualcomm. We also offer a competitive annual discretionary bonus program and opportunity for annual RSU grants (employees on sales-incentive plans are not eligible for our annual bonus). In…
Added 20 mins ago
QI
Software Engineer (San Diego, Boulder)
Qualcomm Incorporate
Boulder, CO
- $109,400 to $164,200 USD / year
…Qualcomm. We also offer a competitive annual discretionary bonus program and opportunity for annual RSU grants (employees on sales-incentive plans are not eligible for our annual bonus). In…
Added 20 mins ago
CB
Personal Banker
Commerce Bank
Centennial, CO
- $22 to $26 USD / hour
Be able to earn more than your base pay through our quarterly incentive program.
Added 21 mins ago
Project Coordinator
Bayport Laboratories LLC
Aventura, FL
…timelines are met. The Project Coordinator works closely with sales staff, clients, and cross-functional teams to assist in the successful launch of products, focusing on timelines, cost…
Added 21 mins ago
Business Development Manager (Investment Strategy)I
Cisco
San Jose, CA
Experience in business development, strategic partnerships, sales, channels, and go-to-market initiatives, collaborating across sales, marketing, and partner organizations.
Added 21 mins ago
Hardware Engineering Technical Leader
Cisco
San Jose, CA
…visibility and the opportunity to influence critical technology development and commodity strategy for Cisco's various product…

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.

Apply on recruiting2.ultipro.com About employer

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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.

Apply on recruiting2.ultipro.com About employer

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Jobs in the United States