Remote Case Management RN - Care Coordinator & Advocate

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

Benefits offered by this job

Remote work options

Performance bonus

401(k) with match

Competitive PTO

Health & dental insurance

Telehealth services

Professional development

Job summary

WPS Health Solutions in Madison, WI seeks a Case Management RN to coordinate care for members with complex needs and develop personalized plans that optimize both quality and cost of care.

You will educate members, liaise with providers, review authorizations, manage transitions of care, and document activities. A Wisconsin RN license or Compact license, 4+ years in varied settings, and CCM/BSN preferred are valued.

Qualifications

• Registered Nurse with Wisconsin licensure or compact license.
• 4+ years of RN experience in varied clinical settings (hospital, clinic, home care, SNF).
• 2+ years in case management.
• Familiarity with care management processes and coordination.
• Knowledge of health plan operations and insurance benefits.

Responsibilities

• Coordinate care for members with complex health needs.
• Develop and monitor member-centric care plans.
• Educate members and families on plans of care.
• Serve as liaison between members, families and providers.
• Review prior authorizations for high-cost services.
• Document care activities and analyze outcomes.

Skills

RN license

Case management

Care coordination

Communication skills

Analytical thinking

Education

BSN preferred

CCM certification preferred

Tools

EMR systems

Microsoft Office

Job description

WPS Health Solutions in Madison, WI seeks a Case Management RN to coordinate care for members with complex needs and develop personalized plans that optimize both quality and cost of care.

You will educate members, liaise with providers, review authorizations, manage transitions of care, and document activities. A Wisconsin RN license or Compact license, 4+ years in varied settings, and CCM/BSN preferred are valued.