Remote RN Case Manager for Care Coordination & Advocacy

WPS Health Solutions; Marion (IL); 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 match

Health insurance

Dental insurance

Telehealth services

Paid time off

Professional development

Job summary

WPS Health Solutions is seeking a Case Management RN to coordinate care for members with complex health needs. You will develop and monitor member-centric care plans, educate members and families on plans of care, and liaise with providers to ensure appropriate utilization of services.

The role requires an RN license (WI or Compact) and 4+ years of RN experience plus 2+ years of case management experience. Remote work is available in specified states; strong communication and EMR/Microsoft

Qualifications

• Registered Nurse with state licensure (Wisconsin) or Compact.
• 4+ years RN experience in varied clinical settings.
• 2+ years case management experience.
• Familiarity with health plan operations, payer/provider relationships, and insurance benefits.

Responsibilities

• Coordinate care and services for case managed members.
• Educate members and families on plans of care.
• Review and decide on prior authorizations for high-cost services.
• Document care management activities and analyze utilization trends.
• Collaborate with cross-functional teams to ensure quality and cost-efficiency.

Skills

RN licensure

Case management

Communication skills

Analytical thinking

Microsoft Office

EMR systems

Education

BSN

Tools

EMR systems

Microsoft Office

Job description

WPS Health Solutions is seeking a Case Management RN to coordinate care for members with complex health needs. You will develop and monitor member-centric care plans, educate members and families on plans of care, and liaise with providers to ensure appropriate utilization of services.

The role requires an RN license (WI or Compact) and 4+ years of RN experience plus 2+ years of case management experience. Remote work is available in specified states; strong communication and EMR/Microsoft