Registered Nurse - Care Coordination

Role Overview As a Registered Nurse specializing in Care Coordination, you will be a vital part of our team, focusing on member populations with intricate health care needs across different settings. Your main goal is to develop and regularly update personalized care plans that ensure effective use of health services while maintaining high quality and cost efficiency for our members. In this role, you will educate members and their families about their care plans and serve as a connector 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, Wisconsin. Is This Opportunity Right for You? If you: Have successfully developed and implemented personalized care plans and established both short-term and long-term goals for members under your care. Enjoy assessing prior authorization requests for high-cost services like transplant procedures, dialysis, and gene therapy treatments. Have experience collaborating with utilization management for specific authorization services. Are passionate about advocating for members' needs and can identify and address obstacles to care. Are skilled in coordinating medical services and resources, ensuring seamless transitions of care, and providing site-of-care redirection as necessary. Like helping members manage their conditions and navigate care transitions effectively. Enjoy educating members and caregivers about community resources, preparation for physician visits, and strategies for medication adherence and overcoming barriers. Can assess psychosocial factors affecting case-managed members and assist them in achieving wellness and independence. Are capable of identifying legal or liability concerns and referring potential ethical or risk management issues to the appropriate department. Can accurately document all care management activities and analyze/report on high-risk, high-cost, or high-utilization cases. Have maintained precise and up-to-date case notes, care plans, and documentation in compliance with health plan guidelines and regulatory standards. Can collaborate with multiple departments to support overall operational efficiency, quality, and compliance with departmental and regulatory standards. Qualifications Current Registered Nurse (RN) licensure in Wisconsin or a current Compact License. Minimum of 4 years of RN experience across a variety of clinical settings (e.g., 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 members. Strong understanding of clinical care management processes, 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, critical thinking, and decision-making skills. Outstanding communication and interpersonal skills to engage 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 such as Point of Service (POS), Preferred Provider Organization (PPO), or Medicare Supplement. Certified Case Manager (CCM) certification is preferred. Technical experience with word processing, spreadsheets, and proficiency in electronic medical record (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 (can be tested at a speed test website). Please refer to the Remote Worker FAQs for further details. Benefits Options for remote work. Performance bonuses and opportunities for merit increases. 401(k) matching program. Generous paid time off policy. Comprehensive health, dental insurance, and 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, based in Madison, Wisconsin. WPS provides a wide range of health insurance plans for individuals, families, seniors, and businesses while also managing benefits for millions of military personnel both on U.S. soil and abroad. For nearly 80 years, we have been dedicated to simplifying healthcare for the individuals 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, diverse insights, and teamwork, enabling us to adapt to changes and seize new opportunities. Our commitment to our people has garnered 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.

Created: 2026-03-04