Case Management RN

Role Snapshot Our Case Management RN (Registered Nurse) coordinates care and services of select member populations with complex health care needs across continuum of care. The primary focus of the role is the development and continuous monitoring of a member‑centric plan of care that promotes effective utilization of health care services while maximizing quality and cost‑efficiency of these services for members. Our Case Management RN routinely educates members and family members on plans of care while serving as a liaison between the members, their families and health care providers. Salary Range $75,000 ~ $100,000 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: Have developed and implemented individualized care plans, short term and long-term goals for case managed members. Enjoy reviewing and providing prior authorization decisions for selective high-cost services including but not limited to transplant, dialysis, CAR-T/gene therapy. Have interfaced with utilization management for select authorization services. Would like serving as an advocate for the member's needs and preferences and can identify and address barriers to care. Would like to coordinate medical services and resources, facilitate transitions of care between settings, and assist with site of care redirections as needed. Can help members manage their conditions and address unique issues during their care transitions. Enjoy educating members and caregivers on appropriate and available community resources, how to prepare for physician visits, and how to overcome barriers and achieve medication compliance. Can assess motivational or psychosocial issues for case managed members and facilitate case management members to achieve wellness and autonomy. Have the ability to identify legal or liability issues and refer potential ethical or risk management issues to the appropriate department for review and resolution. Can document all care management activities and analyze / report care management activities that could include, identification of high risk, high cost and high utilization cases. Have maintained accurate, up-to-date case notes, care plans, and other documentation in compliance with health plan guidelines, state, and federal regulations. Can work cross functionally to support other departmental efforts to ensure overall efficiency, quality, productivity and compliance with all departmental and regulatory standards. Minimum Qualifications Registered Nurse (RN) with current licensure in the state of Wisconsin OR current Compact License. 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 case management experience. Demonstrated experience managing and coordinating care effectively for case managed members. Strong knowledge of clinical care management processes, care coordination, and case management principles. 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). Health insurance background in Point of Service (POS), Preferred Provider Organization (PPO), or Medicare Supplement) plans preferred. Certified Case Manager (CCM) preferred. 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 Please review Remote Worker FAQs for additional information Benefits Remote 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: ( 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. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This 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. #J-18808-Ljbffr WPS Health Solutions