Job Title

Role Overview As a Registered Nurse Care Coordination Specialist, you will play an essential role in our team, focusing on members with complex healthcare needs across various settings. Your primary objective will be to create and consistently update tailored care plans that optimize the use of health services while ensuring high quality and cost efficiency for our members. In this position, you will educate members and their families about their care plans and act as a bridge between them and healthcare providers. Salary Range $75,000 ~ $100,000 The offered salary for this position may vary within the stated range based on your job-related knowledge, skills, and experience. We welcome remote applicants from various states, including Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, and Wisconsin. Is This Opportunity Right for You? If you: Have successfully created and executed personalized care plans, establishing both short-term and long-term goals for your members. Enjoy reviewing prior authorization requests for high-cost services such as transplant procedures and gene therapy treatments. Have experience collaborating with utilization management for specific authorizations. Are passionate about advocating for members' needs and can identify and tackle barriers to care. Are skilled in ensuring seamless transitions of care and providing site-of-care redirection as necessary. Like assisting members in managing their conditions and navigating care transitions effectively. Enjoy educating members and caregivers about community resources and strategies for medication adherence. Can assess psychosocial factors affecting your cases and assist members in achieving wellness and independence. Are able to recognize legal or liability concerns and refer potential ethical issues to the appropriate department. Can accurately document all care management activities and analyze/report on high-risk and high-utilization cases. Have maintained precise and compliant case notes, care plans, and documentation in accordance with health plan guidelines and regulatory standards. Can work collaboratively with multiple departments to support operational efficiency and compliance. Qualifications Current Registered Nurse (RN) licensure in Wisconsin or a current Compact License. Minimum of 4 years of varied RN experience (hospital, clinic, home care, skilled nursing facility). At least 2 years of direct case management experience. Proven ability to effectively manage and coordinate care for your members. Strong understanding of clinical care management, care coordination, and case management principles. Keen familiarity with health plan operations, payer/provider relationships, and insurance benefits. Demonstrated capacity to work independently, manage a caseload, and prioritize effectively. Excellent analytical and critical thinking skills. Outstanding communication skills to engage effectively with members, providers, and teams. Proficient in Microsoft Office and healthcare software applications. Preferred Qualifications Bachelor's degree in nursing (BSN). Experience with health insurance plans including POS and PPO. Certification as a Case Manager (CCM) is preferred. Technical experience with word processing, spreadsheets, and proficiency in EMR systems or other managed care software. Remote Work Requirements High-speed cable or fiber internet connection. Minimum speed of 10 Mbps downstream and 1 Mbps upstream. Please refer to the Remote Worker FAQs for further details. Benefits Options for remote work. Performance bonuses and opportunities for merit-based increases. 401(k) matching program. Generous paid time off policy. Comprehensive health and dental insurance, plus telehealth services effective from DAY 1. Access to professional and leadership development programs. About Us WPS is a not-for-profit health solutions company and a leader in health insurance and federal government contracting. We provide a broad range of health insurance plans while managing benefits for millions of military personnel both domestically and internationally. For nearly 80 years, we have focused on simplifying healthcare for those we serve. Our Culture Drives Our Success The culture at WPS is designed to inspire, support, and reward our employees. We foster an environment that values engagement and teamwork, enabling us to adapt to changes and seize new opportunities. Our commitment to our people has earned us recognition from various local and national organizations. Join Us! Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. This employer must notify all applicants of their rights under federal employment laws. For more information, please review the Know Your Rights notice from the Department of Labor.