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Senior IT Applications Engineer II - Automotive Captive Finance
American Honda Motor Co., Inc.
Torrance, CA
Reporting to the CASS AF Team Manager, the Team Lead is accountable for associate development, performance management, work assignment, capacity planning, technical quality, production…
Added just now
NY
Office Manager (Bilingual Spanish)
New York Psychotherapy and Counseling Center
The Bronx, NY
- $90,000 to $110,000 USD / year
Career growth through our Academy and leadership development programs
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Building Automation Specialist-HVAC
University of Iowa
IA
…Residence and Dining Halls. Work includes construction project development, maintenance repair coordination, troubleshooting of building equipment and systems as well as communicating…
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Universal Banker Bilingual (English/Spanish) - Bulls Head Branch
ESL All Companies
Rochester, NY
- $22.02 USD / hour
…employees. Our benefits include robust options such as our wellness program, family assistance plan, 401k with match, paid volunteer time and Learning & Development training among many…
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UG
Clinical Pharmacist - Remote
UnitedHealth Group
Phoenix, AZ
- $91,700 to $163,700 USD / year
Present patient case examples of successful MTM interventions and Care Team impact to program leadership, health plan executives, and/or external providers
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Director of Sales
TerraBella Indian Trail
Monroe, NC
…who we are. We continually aspire and invest in learning and development opportunities that support our team members’ professional growth, ensuring every team member has the tools to build…
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Transmission Planning Program Manager - Transmission Planning & Protection
FirstEnergy
Akron, OH · Greensburg, PA · Fairmont, WV · Reading, PA
The Transmission Planning Program Manager leads the development of early-stage transmission projects that support large load interconnections, transmission reliability initiatives…
Added 1 min ago
Assistant Director of Facilities
East Carolina University
NC
…2015, 2024), as well as its 2024 designation as a Carnegie Leadership for Public Purpose institution. These distinctions recognize the university’s leadership in translating research into…
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Patient Care Coordinator
Compass Health Center
Brookfield, WI
…adolescent and adult programs from the ground up alongside the leadership of well-established clinicians, psychiatrists, nurse practitioners, and nurses working in PHP/IOP behavioral health…
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Adult Group Therapist
Compass Health Center
Brookfield, WI
…adolescent and adult programs from the ground up alongside the leadership of well-established clinicians, psychiatrists, nurse practitioners, and nurses working in PHP/IOP behavioral health…
Added 1 min ago
Yankee Candle - Store Manager - Natick, MA
United States
…action: Integrity, Teamwork, Passion for Winning, Ownership, and Leadership. We work together to win, grow, and make a real impact - supported by a high-performing, inclusive, and…
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Yankee Candle - Seasonal 2nd Assistant Store Manager - Chesterfield, MO
United States
…action: Integrity, Teamwork, Passion for Winning, Ownership, and Leadership. We work together to win, grow, and make a real impact - supported by a high-performing, inclusive, and…
Added 1 min ago
NM
Registered Nurse-Observation Unit Full Time Nights
Northwestern Memorial Healthcare
Chicago, IL
- $36.5 to $58.4 USD / hour
- Full-time
…the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation…
Added 1 min ago
UO
Registered Nurse (RN) - Transplant Infusion Center
University of Virginia
Charlottesville, VA
- $41.05 to $54.15 USD / hour
…feedback for improved clinical practice. Assumes a beginning leadership role but seeks mentoring in this…
Added 1 min ago
UO
Registered Nurse (RN) - Heart Clinic (Wage)
University of Virginia
Charlottesville, VA
- $38.66 to $50.97 USD / hour
Supportive leadership that prioritizes employee success, flexibility, and professional development.
Added 1 min ago
TT
HVAC Instructor (Part-Time)
Tidewater Tech
Norfolk, VA
- Up to $35 USD / hour
- Part-time
Collaborate with the Program Coordinator and Campus leadership on scheduling and student outcomes.
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TT
HVAC Instructor (Part-Time)
Tidewater Tech
Norfolk, VA
- Up to $35 USD / hour
- Part-time
Collaborate with the Program Coordinator and Campus leadership on scheduling and student outcomes.
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Make Ready Technician
Blue Roc Premier Family of Companies
Mobile, AL
…valuable addition to our team. We prioritize the growth and development of our staff, offering an outstanding training program aimed at cultivating strong leadership abilities in…
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Commercial Counsel
GHX
Remote, United States
Collaborate with cross-functional teams to support product development and ensure compliance with applicable laws and regulations.
Added 1 min ago
BF
Inventory Supervisor
Blount Fine Foods
Fall River, MA
- $60,000 to $65,000 USD / year
Is responsible for the oversight, development and effectiveness of inventory team members and the overall inventory program for the facility.
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SD
Director Client Outcomes - Remote US
Smile Digital Health
Remote, United States
- $160,000 to $180,000 USD / year
Provide regular reporting and analyses to leadership on Client status and account health.
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Data Product Lead, External Data
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…employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive…
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High School Assistant Principal
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McDonald, PA
5 or more years of building leadership experience, preferred
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Store Leader - Delray Beach
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VH
Supervisory Social Worker (HUD VASH Program)
Veterans Health Administration
Kansas City, MO
- $129,114 to $167,850 USD / year
The Supervisory Social Worker serves as the Housing and Urban Development-VA Supportive Housing (HUD-VASH) Program Supervisor within the Mental Health Service Line at the Kansas City VA…

WPS Health Solutions

Utilization Management RN

Denver, CO, United States

$40,123 USD / year

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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.

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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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