Remote Case Management RN: Advocate & Care Coordinator

WPS Health Solutions; Madison (WI); Remote; USD 75,000 - 100,000; Full time

Benefits offered by this job

Performance bonus

401(k) with 100% match up to 3%, 50% 4

Paid time off

Health and dental insurance + telehe

Professional and leadership dev

Job summary

WPS Health Solutions in Madison, Wisconsin, is seeking a Case Management RN to coordinate care for members with complex health needs. You will develop and monitor member-centric plans to improve quality and cost-efficiency, and educate members and families as a liaison between members, families and providers.

The role requires RN licensure in Wisconsin or a valid Compact license, 4+ years of RN experience, 2+ years in case management, and strong communication.

Qualifications

• RN license in Wisconsin or current Compact License.
• 4+ years of RN experience in varied clinical settings.
• 2+ years of case management experience.
• Strong knowledge of clinical care management processes, care coordination, and case management principles.
• Familiarity with health plan operations, payer/provider relationships, and insurance benefits.
• Proficiency in Microsoft Office and healthcare software.

Responsibilities

• Develop and implement individualized care plans and short/long-term goals for case-managed members.
• Review and make prior authorization decisions for high-cost services (e.g., transplant, dialysis, CAR-T/gene therapy).
• Coordinate medical services and resources across care settings; support transitions of care.
• Act as advocate for member needs, addressing barriers to care.
• Educate members and caregivers on community resources, physician visits, and medication adherence.
• Document care management activities and analyze data to identify high-risk/high-cost cases.

Skills

RN license in WI or Compact

Case management experience

Care coordination

Microsoft Office & healthcare software

Communication & interpersonal skills

Documentation & data reporting

Education

BSN

Tools

EMR systems

Job description

WPS Health Solutions in Madison, Wisconsin, is seeking a Case Management RN to coordinate care for members with complex health needs. You will develop and monitor member-centric plans to improve quality and cost-efficiency, and educate members and families as a liaison between members, families and providers.

The role requires RN licensure in Wisconsin or a valid Compact license, 4+ years of RN experience, 2+ years in case management, and strong communication.