Remote Case Management RN - Care Coordinator & Advocate

WPS Health Solutions; Denver (CO); Remote; USD 75,000 - 100,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) match

Paid time off

Health insurance

Dental insurance

Telehealth

Job summary

WPS Health Solutions is a health insurer and federal contractor seeking a Case Management RN to coordinate care for members with complex needs, developing and monitoring a member-centric plan while educating families and liaising with providers.

The role emphasizes prior authorization for high-cost services, care transitions, and advocacy, with remote options available in many states. BSN preferred; CCM is a plus; strong analysis, communication, and IT skills required.

Qualifications

• RN with current Wisconsin license or Compact License.
• 4+ years experience as RN in varied clinical settings.
• 2+ years of case management experience.
• Demonstrated experience managing and coordinating care for case managed members.
• Familiarity with health plan operations, payer/provider relationships, and insurance benefits.

Responsibilities

• Coordinate care and develop member-centric care plans.
• Educate members and families on plans of care.
• Serve as liaison between members, families and providers.
• Review and decide on prior authorizations for high-cost services.
• Coordinate transitions of care and site of care redirections.
• Document care management activities and analyze data to identify high risk, high cost, high utilization.
• Work cross-functionally to ensure efficiency, quality, productivity and regulatory compliance.

Skills

Registered Nurse

Case management

Communication skills

Microsoft Office

EMR systems

Education

BSN

CCM certification

Tools

EMR systems

Healthcare software

Job description

WPS Health Solutions is a health insurer and federal contractor seeking a Case Management RN to coordinate care for members with complex needs, developing and monitoring a member-centric plan while educating families and liaising with providers.

The role emphasizes prior authorization for high-cost services, care transitions, and advocacy, with remote options available in many states. BSN preferred; CCM is a plus; strong analysis, communication, and IT skills required.