RN Care Manager - Condition/Disease Management Focus

Network Health; Menasha (WI); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Network Health is seeking a Registered Nurse Care Manager to provide comprehensive case management across the healthcare continuum. You will assess, plan, implement, coordinate, and advocate for members to achieve quality, cost-effective outcomes.

The role requires Wisconsin RN licensure, a Bachelor’s degree in Nursing preferred, and four years of clinical experience. The position is 1.0 FTE, based in Wisconsin with home-office eligibility and occasional travel to the Menasha corporate office.

Qualifications

• RN licensure in Wisconsin is required or actively in-progress.
• Bachelor's degree in Nursing preferred.
• Case management certification preferred.
• Four years of clinical health care experience as an RN required.
• Experience with chronic condition management (diabetes, cardiac, pulmonology) preferred.
• Experience with Medicare/Medicaid preferred.

Responsibilities

• Screen candidates for case management and complete assessments, care plans, and timeframes for re-assessment using evidence-based guidelines.
• Review results from medical/behavioral tests and update care plans to reflect progress.
• Provide information and outreach regarding case/condition management to members, caregivers, providers, and staff.
• Evaluate and process member referrals from physicians to other providers.
• Assess, plan, facilitate, and advocate for quality, cost-effective interventions and resources.
• Work with members and families on self-management using coaching techniques (motivational interviewing).
• Educate individuals and families about conditions, medications, resources, and insurance benefits.

Skills

RN licensure WI

Case management experience

Medicare/Medicaid knowledge

Chronic disease management

Education

Bachelor's degree in Nursing

Case Management certification preferred

Job description

The Registered Nurse Care Manager provides case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across the healthcare continuum. The Care Manager advocates for options and services to meet an individual's and family's comprehensive health needs through communication and coordination of available resources to promote quality, cost-effective outcomes.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day.

Hours:1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference.

Job Responsibilities

• Screen candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes for re-assessment using evidence-based clinical guidelines. Evaluate and determine member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies
• Review results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; close cases when expected goals/outcomes are achieved
• Provide information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff
• Evaluate and process member referrals from physicians to other specialty providers
• Assess, plan, facilitate and advocate for individuals to identify quality, cost effective interventions services and resources to ensure health needs are met
• Works with members and families on self-management approaches using coaching techniques such as motivational interviewing
• Educate the individual, his/her family and caretakers about case and condition management, the individual's health condition(s), medications, provider and community resources and insurance benefits to support quality, cost effective health outcomes.
• Facilitate the coordination, communication and collaboration of the individual's care among his/her providers including tertiary, non-plan providers and community resources with the goal of controlling costs and improving quality.
• Schedule visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning.
• Stay abreast of current best practices and new developments
• Other duties as assigned

Job Requirements

• Graduation from accredited school of nursing
• Bachelor's degree in Nursing preferred
• RN licensure in the State of Wisconsin
• Case Management certification preferred
• Four years of clinical health care experience as a RN required
• Chronic condition management experience preferred, especially:
  • Diabetes
  • Cardiac
  • Pulmonology
• Previous experience in case management, utilization management, insurance, or managed care preferred
• Experience with Medicare, Medicaid preferred

Network Health is an Equal Opportunity Employer

Equal Opportunity Employer. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.