CM Utilization Management Nurse

JOB REQUIREMENTS: Group Health Cooperative of South Central Wisconsin.BETTER TOGETHER This is a full-time role (40 hours per week). Followingan initial onboarding and training period, the position will be fullyremote. Candidates must be residents of Wisconsin. Using a collaborativeprocess, the Care Management (CM) Utilization Management Nurse (RN) willreview, plan, implement, monitor, and evaluate the options and servicesrequired to meet an individual's health needs, using communication andavailable resources to promote quality, and cost-effective outcomes.They help identify appropriate providers and facilities throughout thecontinuum of services while ensuring that available resources are beingused in a timely and cost-effective manner while maintaining quality ofcare. The CM Utilization Management Nurse is responsible for evaluatingthe medical appropriateness, quality, and cost effectiveness of proposedservices in accordance with established criteria. This review activitymay be conducted prospectively, concurrently, or retrospectively and incollaboration with patients, practitioners, and other professionals.They play an integral role in working with the RN and Social Work CaseManagers on an ongoing basis and providing support. They provide supportand is a resource for the Care Management Associates and other staff.Work is performed under the general direction, guidance, and supervisionof the Care Management Department Manager. GHC-SCW is a quality drivencooperative built on collaboration, community involvement, innovation,and belonging. In dedication to the health and well-being of ouremployees, we offer a comprehensive benefits package that includeshealth and dental insurance, along with paid parental leave, short-termdisability, long-term disability, and life insurance. Additionalbenefits include a flexible spending account, employee assistanceprograms, tuition reimbursement, pet insurance, eyewear discounts, andmore. Check us out by clicking on Many Talents, One Mission TheBenefits of Working at GHC-SCW. Job Specific Minimum QualificationsGraduation from an NLN accredited school of Nursing. Bachelor's degreeis preferred. Valid current license to practice in the State ofWisconsin as a Registered Nurse is required. Minimum of one (1) yearexperience in: Utilization Review, Insurance/Managed Care, Home Healthand/or diversified clinical experience, two (2) years preferred.Knowledge of utilization principles, methods, and techniques withexperience in primary and/or acute care management. Ability to followestablished criteria, policies, and procedures utilized in medicalreviews. Ability to keep abreast of legal... For full info followapplication link. Group Health Cooperative is an Equal OpportunityEmployer and all qualified applicants will receive consideration foremployment without regard to race, color, religion, sex, sexualorientation, gender identity, national origin, veteran status ordisability. APPLICATION INSTRUCTIONS: Apply Online:ipc.us/t/9C481BB832924D11

Created: 2026-01-12