Utilization Management RN - Remote

Utilization Management RN role focusing on evaluating medical necessity and appropriateness of services using MCG criteria and UM platforms, collaborating with Medical Directors, and engaging in continuous learning across care continuum. Responsibilities include applying evidence-based criteria, consulting on difficult cases, and supporting departments through change management. Qualifications include a BSN, active RN license (WI or multi-state), 1+ year experience; preferred experience in managed care, CPT/ICD-10/HCPCS knowledge, and health plan experience. Remote-first role with approved state coverage and required reliable internet.