Remote Case Manager RN: Care Coordination & Advocacy

WPS—A health solutions company; Madison (WI); Remote; USD 75,000 - 100,000; Full time

Benefits offered by this job

Remote work options available

Performance bonus

401(k) with match

Paid time off

Health insurance

Dental insurance

Telehealth services

Professional development programs

Job summary

WPS Health Solutions in Madison is seeking a Case Management RN to coordinate care for members with complex needs and develop individualized plans of care. You’ll educate members and families, act as a liaison among members, families and providers, and help optimize quality and cost-efficiency.

Remote options are available in approved states; strong clinical judgment, care coordination, and documentation skills are essential. Experience with prior authorizations preferred.

Qualifications

• RN licensed in Wisconsin or with a valid Compact License.
• 4+ years as RN in varied clinical settings.
• 2+ years in case management.
• Experience coordinating care and developing care plans.
• Knowledge of health plan operations and payer/provider relationships.
• Proficiency in Microsoft Office and healthcare software.

Responsibilities

• Coordinate care and develop member-centric plans.
• Review and render prior authorization decisions for high-cost services.
• Advocate for members and address barriers to care.
• Coordinate transitions of care and site of care redirection.
• Document care management activities and analyze outcomes.

Skills

RN licensure

Case management

Communication

Analytical skills

Microsoft Office

Healthcare software

Education

BSN

BSN preferred

Tools

EMR systems

Healthcare software

Job description

WPS Health Solutions in Madison is seeking a Case Management RN to coordinate care for members with complex needs and develop individualized plans of care. You’ll educate members and families, act as a liaison among members, families and providers, and help optimize quality and cost-efficiency.

Remote options are available in approved states; strong clinical judgment, care coordination, and documentation skills are essential. Experience with prior authorizations preferred.