Remote Case Management RN — Care Coordinator & Advocate

WPS—A health solutions company; North Carolina; Remote; USD 75,000 - 100,000; Full time

Benefits offered by this job

Remote work options

Bonus opportunities

401(k) match

Paid time off

Health insurance

Dental insurance

Telehealth

Leadership development

Job summary

WPS, a health solutions company, seeks a Case Management RN to coordinate care and develop member-centric plans across the continuum of care. You will educate members and families, and serve as a liaison among members, families, and health care providers.

The role includes reviewing complex, high-cost service authorizations, supporting transitions of care, and maintaining detailed documentation per guidelines.

Qualifications

• Registered Nurse with current licensure in Wisconsin or Compact License.
• 4+ years of RN experience in varied clinical settings.
• 2+ years of case management experience.
• Experience coordinating care and documenting activities per health plan guidelines.
• Familiarity with health plan operations and payer/provider relationships.

Responsibilities

• Coordinate care and services for case managed members across the continuum of care.
• Educate members and families on plans of care.
• Review and provide prior authorization decisions for high-cost services (e.g., transplant, dialysis, CAR-T/gene therapy).
• Interface with utilization management for authorization services.
• Advocate for members' needs and address barriers to care.
• Coordinate medical services and resources; facilitate transitions of care between settings.
• Assist with site of care redirections as needed.
• Document care management activities and analyze reports on high risk/high cost cases.

Skills

Independence

Case load management

Prioritization

Analytical skills

Critical thinking

Problem solving

Decision making

Communication skills

Interpersonal skills

Microsoft Office

Healthcare software

EMR systems

Education

Bachelor’s degree in nursing (BSN)

Tools

Microsoft Word

Spreadsheets

EMR systems

Job description

WPS, a health solutions company, seeks a Case Management RN to coordinate care and develop member-centric plans across the continuum of care. You will educate members and families, and serve as a liaison among members, families, and health care providers.

The role includes reviewing complex, high-cost service authorizations, supporting transitions of care, and maintaining detailed documentation per guidelines.