Remote Case Management RN — Lead Care Plans & Transitions

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

Benefits offered by this job

Remote work options available

Performance bonus and/or merit

401(k) with a 100% match for the first

Paid time off

Health insurance

Dental insurance

Telehealth services

Professional and Leadership Developmnt

Job summary

WPS is seeking a Case Management RN to coordinate care for members with complex health needs. You will develop and monitor member-centered care plans, educate members and families, and serve as a liaison between members, families, and providers across the continuum of care.

The role involves reviewing prior authorizations for high-cost services, managing caseloads, and ensuring adherence to health plan guidelines.

Qualifications

• Active RN license in Wisconsin or a valid Compact license.
• 4+ years of RN experience in varied clinical settings (hospital, clinic, home care, SNF, etc.).
• 2+ years of case management experience.
• Ability to manage a caseload independently and prioritize.
• Strong knowledge of clinical care management and coordination.

Responsibilities

• Coordinate care and develop member-centric plans across the care continuum.
• Review prior authorization decisions for high-cost services (e.g., transplant, dialysis, CAR-T).
• Serve as liaison between members, families and providers.
• Document care management activities and maintain case notes in compliance with guidelines.

Skills

RN licensure

Case management

Healthcare coordination

Communication skills

Microsoft Office

EMR proficiency

Education

BSN preferred

Tools

EMR systems

Healthcare software

Job description

WPS is seeking a Case Management RN to coordinate care for members with complex health needs. You will develop and monitor member-centered care plans, educate members and families, and serve as a liaison between members, families, and providers across the continuum of care.

The role involves reviewing prior authorizations for high-cost services, managing caseloads, and ensuring adherence to health plan guidelines.