Remote Case Management RN — Care Coordination Pro

WPS—A health solutions company; Michigan; A distancia; USD 75.000 - 100.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work options

Performance bonus

401(k) with 100% match for first 3%

Paid time off

Health and dental insurance starting 1

Descripción de la vacante

WPS Health Solutions is hiring a Case Management RN to coordinate care for members with complex health needs. The role focuses on developing and monitoring individualized care plans that maximize quality and cost-efficiency, while educating members and families and serving as a liaison with providers.

Ideal candidates have 4+ years as an RN and 2+ years in case management, with strong skills in care coordination and communication.

Formación

• Licensed RN in WI or a valid compact license.
• 4+ years of RN experience in varied clinical settings (e.g., hospital, clinic, home care, SNF).
• 2+ years of case management experience.
• Experience managing and coordinating care for case managed members.
• Strong knowledge of care management processes, care coordination, and case management principles.
• Proficiency with Microsoft Office and healthcare software.

Responsabilidades

• Coordinate care and services for member populations with complex health care needs.
• Develop and monitor a member-centric plan of care to optimize quality and cost efficiency.
• Educate members and families on plans of care and serve as liaison with providers.
• Review prior authorization decisions for high-cost services (e.g., transplant, dialysis).
• Identify barriers to care and advocate for members’ needs.
• Coordinate transitions of care across settings and site of care redirections as needed.
• Document care management activities and analyze data for risk and utilization.

Conocimientos

Case management experience

Care coordination

Communication skills

Microsoft Office

Healthcare software

Educación

RN license

BSN preferred

Herramientas

EMR systems

Descripción del empleo

WPS Health Solutions is hiring a Case Management RN to coordinate care for members with complex health needs. The role focuses on developing and monitoring individualized care plans that maximize quality and cost-efficiency, while educating members and families and serving as a liaison with providers.

Ideal candidates have 4+ years as an RN and 2+ years in case management, with strong skills in care coordination and communication.