RN Case Manager: Care Coordination Expert

Mercy-Health-System-Corporation; Janesville (WI); Hybrid; USD 64,000 - 97,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

FSA/HSA Options

Paid Time Off

Parental Leave

Tuition Reimbursement

Career advancement opportunities

Job summary

Mercyhealth is seeking an experienced Case Manager RN in Wisconsin to coordinate patient care, improve outcomes, and ensure NCQA/HEDIS compliance. The role focuses on developing individualized care plans, monitoring progress, and collaborating with providers and staff.

The position emphasizes education, policy adherence, and quality improvement within Mercyhealth’s clinical operations. The role requires a nursing degree, RN licensure, and preferred CCM certification, with a full-time schedule

Qualifications

• Graduate of an accredited nursing program.
• BSN or upon hire BSN completion agreement for enrollment in an accredited BSN Completion Program
• ADN RN or RN Diploma Degree preferred two years related experience.

Responsibilities

• Provide direct case management activities for members.
• Collects in depth information to develop comprehensive case management plans.
• Determine benefits/coverage of medical necessity per Mercyhealth policy.
• Execute interventions to achieve goals in the management plan.
• Monitor plan effectiveness and modify as needed.
• Educate provider offices and hospital staff on case management policies.
• Support quality initiatives and committee activities.

Skills

Case management

RN

CCM certification

Education

BSN preferred

ADN RN or RN Diploma

Job description

Mercyhealth is seeking an experienced Case Manager RN in Wisconsin to coordinate patient care, improve outcomes, and ensure NCQA/HEDIS compliance. The role focuses on developing individualized care plans, monitoring progress, and collaborating with providers and staff.

The position emphasizes education, policy adherence, and quality improvement within Mercyhealth’s clinical operations. The role requires a nursing degree, RN licensure, and preferred CCM certification, with a full-time schedule