Jobs in the United States

25+ jobs

Added 1 min ago
Manager, Healthcare Services People Partners
SelectQuote, Inc.
Overland Park, KS
…strategies and decisions and analyzing data to develop solutions programs and…
Added 1 min ago
Range Master Supervisor (2 positions)
State of Arizona
PHOENIX, AZ
…check us out and see what we’re all about! Consider joining our workforce today. AZGFD celebrates the diversity of Arizona's people, landscapes and of course, wildlife. However you choose…
Added 6 mins ago
M
Training & Safety Coordinator
Mattel
Fort Worth, TX
- $20 to $24 USD / hour
…training while supporting environmental, health, and safety programs that protect employees, promote regulatory compliance, and strengthen a proactive safety culture. The role provides…
Added 7 mins ago
GS
Director, People & Culture, Care Delivery Assets
GRP SCAN Group
United States
- $180,000 to $210,000 USD / year
The Director, People & Culture, Care Delivery Assets is a trusted advisor to senior leadership, responsible for shaping workforce and organizational strategies that advance business…
Added 8 mins ago
Product Manager - US Downstream Airways Marketing - Acute Care and Monitoring
COV Covidien LP
Lafayette, CO
The Product Manager for the US Acute Care & Monitoring team will be responsible for developing downstream marketing activities for the Core Airways portfolio. This entails creating…
Added 11 mins ago
Wastewater Treatment Plant Manager - Brightwater
King County
Woodinville, WA
…(ESJ). We value diverse perspectives and life experiences in our workforce and are committed to building a culturally diverse and inclusive environment. WTD strives to provide equitable…
Added 11 mins ago
Director, Operations & Service Delivery
WCG Clinical
Greenwood Village, CO
Resources that support your whole life – Employee assistance programs and work/life balance tools
Added 12 mins ago
DG
Customer Insights & Analytics Manager
Discover Goodwill of Southern & Western Colorado
Colorado Springs, CO
- $85,000 to $95,000 USD / year
The Customer Insights and Analytics Manager partners across Marketing and Customer Experience, Retail Operations, Development, Community Programs, Finance, Information Technology (IT), and…
Added 12 mins ago
O
Senior Manager - Quality Engineering
Oracle
Denver, CO
- $126,200 to $264,100 USD / year
The Senior Manager, Quality Engineering is responsible for leading the Quality Engineering organization and ensuring the effective execution of quality strategies across manufacturing…
Added 12 mins ago
O
Manager, Data Center Support Services - Onsite in Anthony, NM
Oracle
Denver, CO
- $102,300 to $209,500 USD / year
True innovation starts when everyone is empowered to contribute. That’s why we’re committed to growing a workforce that promotes opportunities for all with competitive benefits that support…
Added 13 mins ago
Onsite Medical Representative
Amazon.com Services LLC
Lakeland, FL
…environments to proactively manage the health and wellbeing of our workforce. To support these goals, Amazon is seeking an experienced and dynamic Onsite Medical Representative (OMR) to…
Added 31 mins ago
TC
Shop Service Intern
Terex Corporation
Kent, WA
- $18 to $24 USD / hour
Utilize Services Software and other related computer programs
Added 39 mins ago
People Partner
Jam City
San Francisco, CA
Jam City is looking for a People Business Partner, located in our San Francisco office. They will report to the Senior Manager, Talent Management, and partner with leaders across assigned…
Added 46 mins ago
SO
Public Service Executive
State of Iowa
Des Moines, IA
- $55.41 to $86.5 USD / hour
…IPERS’ mission is to support its membership – Iowa’s public workforce – with the prudent management of the IPERS Trust…
Added 46 mins ago
SO
Fisheries Program Manager
State of Iowa
Des Moines, IA
- $33.69 to $52.11 USD / hour
As the Fisheries Program Manager, you will be at the forefront of this mission, serving as the principal decision-maker for our multi-million-dollar capital improvement and federal grant…
Added 47 mins ago
Director of Human Resources, Compliance and Employee Relations (In-Office)
KemperSports - New
Northbrook, IL
Lead programs that support compliance with federal, state, and local employment requirements.
Added 49 mins ago
O
Principal Program Manager (OCI Cloud Expansion)
Oracle
Nashville, TN
- $91,000 to $209,500 USD / year
Join Oracle’s cloud infrastructure organization at the forefront of global cloud expansion. As a Program Manager, you will lead the end-to-end delivery of complex cloud build programs in…
Added 49 mins ago
O
Senior Manager, Core Infrastructure Engineering
Oracle
Santa Clara, CA · Seattle, WA · Pleasanton, CA
- $146,300 to $306,400 USD / year
As the Senior Manager in OCI, you will provide leadership to a dedicated team tasked with overseeing the end-to-end lifecycle of infrastructure projects within OCI. Your role will involve…
Added 49 mins ago
O
Consulting Technical Manager
Oracle
Reston, VA
- $102,300 to $209,500 USD / year
True innovation starts when everyone is empowered to contribute. That’s why we’re committed to growing a workforce that promotes opportunities for all with competitive benefits that support…
Added 59 mins ago
C
Area Director -- BYU-Pathway Worldwide - (Full-time)
Church
Salt Lake City, UT
- Full-time
…direction and operational oversight for a geographically dispersed workforce of approximately 200 to 400 senior service missionaries, ensuring alignment with organizational priorities and…
Added 1 hour ago
Associate Security Officer - Security
Providence St. Joseph Health
Walla Walla, WA
Receives general direction from the Security Services Supervisor or Manager. Fulfills all the duties and responsibilities required for customer service and maintaining a secure and orderly…
Added 1 hour ago
K
Sr. Program Manager
Kentro
McLean, VA
- $175,000 to $225,000 USD / year
Kentro is hiring an experienced Senior Program Manager to support the US Agency for International Development (USAID). In this role, you will oversee the delivery of technical,…
Added 1 hour ago
OR
Wireless Retail Sales Associate - W1539
OSL Retail Services
ONTARIO, OH
- $17 USD / hour
We are committed to employing a diverse workforce and are an equal-opportunity employer. Qualified applicants will receive consideration regarding race, color, religion, sex, national…
Added 1 hour ago
Biomedical Technician
Fresenius Medical Care
Huber Heights, OH
…as well as a leadership path from Area Technical Operations Manager, Regional Technical Operations Manager, and Senior Director Technical Services, overseen by a Vice President of Technical…
Added 1 hour ago
Regional Human Resources Manager
JB Roofing, a Tecta America Company, LLC
Tiffin, OH
…what sets us apart. We are seeking a Regional Human Resources Manager that will be based out of our Indianapolis IN office and will support our Mid-America Region (IN, OH, PA & KY) The…

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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