Remote Case Management RN: Care Coordination Expert

WPS Health Solutions; Columbus (OH); Remote; USD 75,000 - 100,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) match

PTO

Health insurance

Telehealth services

Leadership development programs

Job summary

WPS Health Solutions is seeking a Case Management RN to coordinate care for members with complex health needs. You will develop and monitor member-centric plans of care, educate members and families, and liaise with providers to optimize quality and cost-efficiency.

The role requires a Wisconsin RN license or Compact license, 4+ years of RN experience, and 2+ years in case management. Remote work is available in approved states; strong analytical and communication skills are essential.

Qualifications

• Registered Nurse with current licensure in the state of Wisconsin or current Compact License.
• 4+ years of experience as an RN in varied clinical settings (hospital, clinic, home care, SNF, etc.).
• 2+ 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.
• Ability to work independently, manage a caseload, and prioritize.
• Excellent analytical, critical thinking, problem‑solving and decision‑making skills.
• Excellent communication and interpersonal skills; proficiency with Microsoft Office and healthcare software/systems.

Responsibilities

• Develop and implement individualized care plans for case managed members.
• Review and provide prior authorization decisions for high-cost services.
• Coordinate medical services and transitions of care between settings.
• Advocate for members’ needs and address barriers to care.
• Document care management activities and analyze high risk/high utilization cases.

Skills

RN licensure

Case management

Communication skills

Analytical thinking

Decision making

Education

BSN

CCM

Tools

EMR systems

Healthcare software

Job description

WPS Health Solutions is seeking a Case Management RN to coordinate care for members with complex health needs. You will develop and monitor member-centric plans of care, educate members and families, and liaise with providers to optimize quality and cost-efficiency.

The role requires a Wisconsin RN license or Compact license, 4+ years of RN experience, and 2+ years in case management. Remote work is available in approved states; strong analytical and communication skills are essential.