Utilization Management Nurse - Remote

Overview

As a Utilization Management Nurse at Wellmark, you'll provide UM services and support to members and healthcare providers, utilizing your clinical knowledge to interpret medical policies and assist members through the continuum of care.

In Short

• Provide utilization management services to members and healthcare providers.
• Interpret medical policies and criteria for UM requests.
• Work collaboratively with a multidisciplinary team.
• Required to work weekends with flexible weekdays.
• Assist in the transition of care for members.
• Document processes and decisions accurately.
• Ensure compliance with regulatory and accreditation standards.
• Strong communication skills are essential.
• Remote work eligible with occasional office visits.
• Focus on member advocacy and resource management.

Requirements

• Completion of an accredited nursing program.
• Active RN or LPN license in Iowa or South Dakota.
• 4+ years of clinical experience.
• Experience in utilization management is preferred.
• Strong verbal and written communication skills.
• Ability to manage multiple priorities.
• Resourceful and self-starting individual.
• Technical acumen with clinical documentation platforms.
• Ability to work independently.
• Commitment to service excellence.

Benefits

• Flexible remote work options.
• Comprehensive health benefits.
• Supportive work environment.
• Opportunities for professional development.
• Commitment to community and sustainability.