WPS—A health solutions company · 2 hours ago
Case Management RN
South Carolina, United States
Full-time
Hybrid
Mid Level
$75K/yr - $100K/yr
4+ years expWPS is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. The Case Management RN coordinates care and services for members with complex health care needs, focusing on developing and monitoring member-centric care plans while educating members and their families on available resources and care transitions.
GovernmentHealth CareHealth Insurance
Responsibilities
Develop and implement individualized care plans, short term and long-term goals for case managed members
Review and provide prior authorization decisions for selective high-cost services including but not limited to transplant, dialysis, CAR-T/gene therapy
Interface with utilization management for select authorization services
Serve as an advocate for the member’s needs and preferences and identify and address barriers to care
Coordinate medical services and resources, facilitate transitions of care between settings, and assist with site of care redirections as needed
Help members manage their conditions and address unique issues during their care transitions
Educate members and caregivers on appropriate and available community resources, how to prepare for physician visits, and how to overcome barriers and achieve medication compliance
Assess motivational or psychosocial issues for case managed members and facilitate case management members to achieve wellness and autonomy
Identify legal or liability issues and refer potential ethical or risk management issues to the appropriate department for review and resolution
Document all care management activities and analyze/report care management activities that could include identification of high risk, high cost and high utilization cases
Maintain accurate, up-to-date case notes, care plans, and other documentation in compliance with health plan guidelines, state, and federal regulations
Work cross functionally to support other departmental efforts to ensure overall efficiency, quality, productivity and compliance with all departmental and regulatory standards
Qualification
Required
Registered Nurse (RN) with current licensure in the state of Wisconsin OR current Compact License
4 or more years of experience as a Registered Nurse in varied clinical settings (i.e., hospital, clinic, home care, skilled nursing facility, etc.)
2 or more years of case management experience
Demonstrated experience managing and coordinating care effectively for case managed members
Strong knowledge of clinical care management processes, care coordination, and case management principles
Familiarity with health plan operations, payer/provider relationships, and insurance benefits
Strong diverse experience and expertise that includes: The ability to work independently, manage a case load, and prioritization
Excellent analytical, critical thinking, problem-solving skills and decision-making skills
Excellent communication and interpersonal skills to work with members, providers, and teams
Proficiency in Microsoft Office and healthcare software and systems
Preferred
Bachelor's degree in nursing (BSN)
Health insurance background in Point of Service (POS), Preferred Provider Organization (PPO), or Medicare Supplement) plans preferred
Certified Case Manager (CCM) preferred
Technical experience with word processing, spreadsheets, and proficiency with electronic medical record (EMR) systems and/or other managed care software
Benefits
Remote work options available
Performance bonus and/or merit increase opportunities
401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (**100% vested immediately**)
Competitive paid time off
Health insurance, dental insurance, and telehealth services start **DAY 1**
Professional and Leadership Development Programs
Company
WPS—A health solutions company
WPS, a health solutions company, is an independent, not-for-profit, local company based in Madison, Wisconsin.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
HealthX Ventures
2025-10-20Series Unknown
Leadership Team
Frank Gumina
Chief Legal and Administrative Officer
Rochelle Myers
Chief Growth Officer and Head of New Ventures
Recent News
2025-11-22
2025-08-04
Company data provided by crunchbase