Case Management RN - United States - WPS Inc

    WPS Inc
    WPS Inc United States

    1 week ago

    Description
    Role SnapshotOur Case Management RN (Registered Nurse) coordinates care and services of select member populations with complex health care needs across continuum of care. The primary focus of the role is the development and continuous monitoring of a member-centric plan of care that promotes effective utilization of health care services while maximizing quality and cost-efficiency of these services for members. Our Case Management RN routinely educates members and family members on plans of care while serving as a liaison between the members, their families and health care providers.
    Salary Range$75,000 ~ $100,000The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.
    We are open to remote work in the following approved states:
    Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, WisconsinHow do I know this opportunity is right for me? If you:
    • Have developed and implemented individualized care plans, short term and long-term goals for case managed members.
    • Enjoy reviewing and providing prior authorization decisions for selective high-cost services including but not limited to transplant, dialysis, CAR-T/gene therapy.
    • Have interfaced with utilization management for select authorization services.
    • Would like serving as an advocate for the member's needs and preferences and can identify and address barriers to care.
    • Would like to coordinate medical services and resources, facilitate transitions of care between settings, and assist with site of care redirections as needed.
    • Can help members manage their conditions and address unique issues during their care transitions.
    • Enjoy educating members and caregivers on appropriate and available community resources, how to prepare for physician visits, and how to overcome barriers and achieve medication compliance.
    • Can assess motivational or psychosocial issues for case managed members and facilitate case management members to achieve wellness and autonomy.
    • Have the ability to identify legal or liability issues and refer potential ethical or risk management issues to the appropriate department for review and resolution.
    • Can document all care management activities and analyze / report care management activities that could include, identification of high risk, high cost and high utilization cases.
    • Have maintained accurate, up-to-date case notes, care plans, and other documentation in compliance with health plan guidelines, state, and federal regulations.
    • Can work cross functionally to support other departmental efforts to ensure overall efficiency, quality, productivity and compliance with all departmental and regulatory standards.
    Minimum Qualifications
    • 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 Qualifications
    • 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.
    Remote Work Requirements
    • High speed cable or fiber internet
    • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at )
    • Please review Remote Worker FAQs for additional information
    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
    • Review additional benefits: )
    Who We Are
    WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
    Culture Drives Our Success
    WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
    We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.
    Sign up for Job Alerts
    FOLLOW US
    Instagram
    LinkedInFacebookWPS Health Blog
    Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
    This employer is required to notify all applicants of their rights pursuant to federal employment laws.

  • Case Manager

    1 month ago

    Only for registered members United States Remote job

    We are seeking certified doulas to join our team as Case Managers. This role focuses on supporting children and pregnant women by providing case management services, including linking them to community resources, coordinating care, and advocating for their needs. · ...

  • Community Health Worker- DFW Medicaid Case Manager

    1 month ago

    Only for registered members United States Remote job

    AEIC Case Management is seeking certified Community Health Workers (CHWs) to serve as Case Managers within the Children & Pregnant Women (C.A.R.E.S.) program. · ...

  • Community Health Worker- Houston/Harris County Medicaid Case Manager

    1 month ago

    Only for registered members United States Remote job

    AEIC Case Management is seeking certified Community Health Workers (CHWs) to serve as Case Managers within the Children & Pregnant Women (C.A.R.E.S.) program. CHWs provide Medicaid-compliant case management services focused on care coordination, resource navigation, client educat ...

  • Case Manager

    1 week ago

    Only for registered members United States

    The Case Manager works in partnership and in a leadership role with physicians and the interdisciplinary team to coordinate the care and service of selected patients across the continuum. · ...

  • Case Manager

    1 week ago

    Only for registered members United States

    Under the direction of the Supervisor Transition of Care, provides clinically based case management to support delivery of effective and efficient patient care. · ...

  • Case Manager

    1 week ago

    Only for registered members United States

    The Case Manager focuses on clinical quality and resource management resulting in defined clinical satisfaction and financial outcomes. · ...

  • Case Manager

    5 days ago

    Only for registered members United States

    The Case Manager's primary responsibility is managing each patient's case throughout the treatment journey. · ...

  • case manager

    3 weeks ago

    Only for registered members United States

    Job summary We are looking for compassionate, energetic, and dependable individuals that are committed to building a culture of kindness for the children receiving services. · Spanish/English bilingual capabilities · The ability to work an 8-hour shift schedule (Tuesday - Saturda ...

  • Case Manager

    1 week ago

    Only for registered members United States

    The Case Manager works in partnership and in a leadership role with physicians and the interdisciplinary team to coordinate the care and service of selected patients across the continuum. This role's underlying objective is to enhance the quality of clinical outcomes and patient ...

  • Case Manager

    6 days ago

    Only for registered members United States

    The role of the Case Manager is to be an advocate for the members. Targets are collective and each team member supports the other in achieving the overall Team's target. · Performing client/members oversight and management of home bound clients/members. · Monitor health care plan ...

  • Case Manager

    2 weeks ago

    Only for registered members United States

    The Case Manager's primary responsibility is managing each patient's case throughout the treatment journey. · ...

  • Case Manager

    1 month ago

    Only for registered members United States Remote job

    Guided Care is seeking a full time Case Manager. This individual obtains prior authorizations and authorization extensions for clients with the goal of ensuring insurance coverage for patient stays and low turnaround times for auth obtainment. · ...

  • Case Manager

    6 days ago

    Only for registered members United States

    The University of New Mexico Health Sciences Center (UNM HSC) Department of Pediatrics encompasses a statewide network of hospitals, · clinics,and community-based services that are integrally linked through education and research. · The Division of Pediatric Hematology/Oncology i ...

  • Case Manager

    17 hours ago

    Only for registered members United States

    The Case Manager focuses on clinical quality and resource management resulting in defined clinical satisfaction and financial outcomes. · The position requires strong written and oral communication skills, analytical and critical thinking skills, conflict management and team-buil ...

  • Case Manager

    3 days ago

    Only for registered members United States

    This is a not-for-profit organization that assists people with intellectual and behavioral challenges to achieve their fullest potential. The Case Manager will provide community-based services to individuals identified as eligible for behavioral health services. This includes ass ...

  • Case Manager

    3 days ago

    Only for registered members United States

    The Case Manager focuses on clinical quality and resource management resulting in defined clinical satisfaction and financial outcomes. · Coordinate patient care to a population of different ages within the Singing River Health System. · ...

  • Case Manager

    2 days ago

    Only for registered members United States

    Under direction determines applicants eligibility for social services available and/or provides other social services related to mental health crisis intervention and case management Interviews clients collects and completes required eligibility documentation determines eligibili ...

  • Case Manager

    5 days ago

    Only for registered members United States Full time

    The candidate will be responsible for assessing and diagnosing clinical nursing problems with patients. · ...

  • Case Manager

    1 month ago

    Only for registered members United States

    The Case Manager will provide all contract funded activities including conducting Intakes Assessments Service Plans Reassessments Service Plan Updates Accompaniment Referrals Advocacy Housing Inspections Case Conference etc. · The Case Manager will ensure clients are connected to ...

  • Case Manager

    1 month ago

    Only for registered members United States

    The Case Manager will provide all contract funded activities such as conducting Intakes Assessments Service Plans Reassessments Service Plan Updates Advocacy Housing Inspections Case Conference etc. · ...

  • RN case manager or SW case manager

    1 week ago

    Only for registered members United States Full time

    +This position comprehensively plans for targeted patient populations. · +Manages all aspects of transition/discharge planning for assigned patients in a timely manner. · Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process fo ...

Jobs
>
Case manager rn