Jobs in the United States

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Added 4 mins ago
Assistant Nurse Manager - Transitional Care Unit
Kaiser Permanente
Honolulu, HI
…models; assisting the implementation of patient care delivery systems and practice standards in several locations; supporting investigations into patient/family/member concerns regarding…
Added 4 mins ago
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Technical Manager - Healthcare Claims Systems
Cognizant
Honolulu, HI
- $71,000 to $112,500 USD / year
As a Technical Manager, you will own the end-to-end health of releases and vendor delivery for healthcare claims systems, serving as the bridge between business stakeholders, internal…
Added 8 mins ago
On Site Company RN - Occupational Medicine
Sanford Health
Gwinner, ND
RN Care Manager, Occupational Medicine will provide health leadership, coordination of services, and the implementation of best practices to support the overall goals of the Occupational…
Added 8 mins ago
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Technical Manager - Healthcare Claims Systems
Cognizant
Bismarck, ND
- $71,000 to $112,500 USD / year
As a Technical Manager, you will own the end-to-end health of releases and vendor delivery for healthcare claims systems, serving as the bridge between business stakeholders, internal…
Added 8 mins ago
S
Unit Safety Manager 2
Sodexo
TIOGA, ND
- $70,975 to $91,850 USD / year
Sodexo Energy and Resources is seeking a Unit Safety Manager to serve as the stand-alone site leader for all Environmental, Health & Safety programs for an Oil and Gas client in Tioga, ND.
Added 8 mins ago
Senior Manager, Software Development
CVS Health
Remote, United States
We’re building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate…
Added 16 mins ago
Territory Manager, Diabetes (Denver North)
MiniMed
Virtual, CO
Must Have: Minimum Requirements · Field Roles: Must have a valid driver's license and active vehicle insurance policy
Added 16 mins ago
FIRE PROTECTION SPECIALIST
U.S. Air Force Academy
Air Force Academy, CO
…purpose of this position is to serve as Assistant Chief for Health and Safety responsible for developing and managing a comprehensive Fire Department Occupational Health and Safety Program…
Added 16 mins ago
Store Manager - The North Face & Columbia
Vail Resorts
Breckenridge, CO
Health Insurance; Medical Insurance, Dental Insurance, and Vision Insurance plans (for eligible seasonal employees after working 500 hours)
Added 16 mins ago
CS
Manager Balance Sheet Strategy – Interest Rate Derivatives, Hedging and BDA Management
Charles Schwab
Lone Tree, CO
- $85,500 to $174,800 USD / year
This Manager role reports to the Senior Manager, Derivatives, Hedging, and BDA Management Lead. You will join a team of traders responsible for Corporate Treasury’s derivatives hedging…
Added 16 mins ago
HH
Lead Surgical Assistant
HCA Healthcare
Lone Tree, CO
- $48.26 to $72.36 USD / hour
B. Education: Graduation from a school of surgical technology approved by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and completion of a First Assistant…
Added 16 mins ago
Brand Manager
Reyes Holdings
Littleton, CO
The Marketing Brand Manager will strengthen supplier relations through development, communication, and monitoring of their business plans
Added 16 mins ago
Quality Engineering Sr Mgr - L6
Lockheed Martin
Littleton, CO
…collaboration and cross-site partnerships; Deliver value-added business health metrics to identify trends and risk areas; Evolve advanced quality; technologies capabilities for increased…
Added 17 mins ago
U
Program Manager RN
UCHealth
Aurora, CO
- $40.86 to $63.33 USD / hour
Collaborates with multidisciplinary teams to assist with problem identification and resolution, cost containment issues, implementation of new services, and systems/performance measures.
Added 17 mins ago
TS
Facilities Manager
The Salvation Army Intermountain Division
Colorado Springs, CO
- $60,000 to $70,000 USD / year
Description Job Title: Facilities Manager FLSA Status: Full Time - Exempt Reports to: Corps Officers & Operations Director Schedule: 40W M-F 8:00AM - 4:30PM, On-call as needed Supervises:…
Added 18 mins ago
M
Lease Construction Manager
Microsoft
TX · Dallas, TX · Dallas
- $97,600 to $206,400 USD / year
The Lease Construction Manager (LCM) is a critical member of Microsoft’s Cloud Operations & Innovation (CO+I) - Datacenter Construction Build Management (DCBM) team responsible for…
Added 29 mins ago
FAST Labs Technology Development Manager / Capture Lead
BAE Systems
Merrimack, NH · Austin, TX
…for purposes of providing discriminating capabilities for BAE Systems. TDMs focus on 1) leadership of research programs as the principal investigator or as the program manager; 2) the…
Added 31 mins ago
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Administrative Assistant 3 | Tacoma Reentry Center
State of Washington
Tacoma, WA
- $4,132 to $5,532 USD / month
…serve as a key administrative partner to the Reentry Center Manager, supporting the overall management of custody staff, community corrections staff, maintenance staff, and food service…
Added 34 mins ago
Dialysis Clinical Manager Registered Nurse - RN
Fresenius Medical Care
Grand Island, NE
Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding,…
Added 35 mins ago
2026 Management & Sales Training Program- Jackson MS
Sherwin-Williams
Jackson, MS · Hattiesburg, MS · Madison, MS
Must have a valid, unrestricted Driver’s License · Must have at least a bachelor's degree by the start of this development program
Added 51 mins ago
CNC Programmer
E.J. Reynolds Company
Alvin, TX
Machining Support - Assist machinists with program interpretation, setups, troubleshooting, and machining best practices.
Added 55 mins ago
Manager, Inspection & Monitoring
Jobgether
Remote, United States
…all applications and next steps. Our partner is looking for a Manager, Inspection & Monitoring based in the United…
Added 57 mins ago
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Backstage Captain, Woodbridge Center - Full Time
Macy's
Woodbridge, NJ
- Full-time
Employee Assistance Program with mental health counseling and legal/financial advice
Added 58 mins ago
M
Selling and Support Captain, Countryside - Full Time
Macy's
Clearwater, FL
- Full-time
Employee Assistance Program with mental health counseling and legal/financial advice
Added 1 hour ago
Manager - Quality Technician Team
RTX
United States
Qualifications You Must Have

WPS Health Solutions

Utilization Management RN

Denver, CO, United States

$40,123 USD / year

Apply on jobs.connectingcolorado.gov About employer

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Job details

Pay: $40,123 USD / year
Posting language: English
Posted: Nov 3, 2026

Original job description

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: 01/10/2027Salary Range: $75,000 ~ $100,000The 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. Sign up for Job Alerts FOLLOW US! Instagram LinkedIn

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Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThis employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.

Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer. Apply at: https://ipc.us/t/23B9A6487560425E.

Apply on jobs.connectingcolorado.gov About employer

More about this job

Skills

RN
Case management
Decision making
Sales
Manage inventory
Reporting
Risk management
Regulatory compliance
Medical coding
Work independently
Prioritization
Critical thinking
Problem solving
Communication skills
Interpersonal skills
Microsoft Office
EMR

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Work requirements

Jobs in the United States