Full-Time Utilization Management Nurse I (Remote)
Wellmark, Inc. is hiring a remote Full-Time Utilization Management Nurse I (Remote). The career level for this job opening is Experienced and is accepting Sioux Falls, SD based applicants remotely. Read complete job description before applying.
Wellmark, Inc.
Job Title
Utilization Management Nurse I (Remote)
Posted
Career Level
Full-Time
Career Level
Experienced
Locations Accepted
Sioux Falls, SD
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Job Details
Use Your Strengths as a Utilization Management Nurse!
About the role:
As a Utilization Management (UM) Nurse, you will provide UM services, transition of care and support to members and health care providers. You will utilize clinical knowledge and expertise to interpret and appropriately apply medical policy, medical necessity criteria (InterQual), and benefit information to provide consultation and responses to UM requests. You will proactively assess and assist members to help move them through the continuum of care by utilizing services and resources efficiently. You will be part of a multidisciplinary team to continuously look for ways to improve processes and maximize health dollars for our members.
What you will do as a Utilization Management I Nurse:
- Provide members and health care providers with appropriate and timely prior approval.
- Provide precertification and continued stay reviews and support to members.
- Work with health care provider staff in a courteous and professional manner.
- Process utilization management requests by utilizing clinical knowledge and expertise.
- Collaborate with other clinical and nonclinical stakeholders.
- Document review processes and decisions accurately.
- Comply with regulatory standards, accreditation standards and internal guidelines.
- Other duties as assigned.
Required Qualifications:
- Completion of an accredited nursing program.
- Active and unrestricted RN or LPN license in Iowa or South Dakota.
- 4+ years of diverse clinical experience.
- Experience in utilization management or health insurance setting beneficial.
- Previous experience working independently and managing an assigned caseload.
- Strong verbal and written communication skills.
- Commitment to service excellence and member advocacy.
- Resourceful self-starter.
- Ability to organize and manage multiple priorities.
- Flexible and adapts to change.
- Develops collaborative relationships.
- Maintains courtesy and professionalism.
- Strong technical acumen.
Candidates located in Iowa or South Dakota preferred. Prior remote work experience a plus! Must be flexible and have the ability work weekend and/or holiday hours when needed to meet business needs.
FAQs
What is the last date for applying to the job?
The deadline to apply for Full-Time Utilization Management Nurse I (Remote) at Wellmark, Inc. is
10th of January 2026
. We consider jobs older than one month to have expired.
Which countries are accepted for this remote job?
This job accepts [
Sioux Falls, SD
] applicants. .
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