Case Management Rn (Health Insurance) - Remote

Who We Are
WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in 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 Health Solutions has been making health care easier for the people we serve for more than 75 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 inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse 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.
From 2021 to 2023, WPS Health Solutions was recognized for several awards:

• Madison, Wisconsin's Top Workplaces
• USA Top Workplaces and the cultural excellence awards for Remote Work and Work-Life Flexibility
• Achievers 50 Most Engaged Workplaces® with the further honor of Achievers "Elite 8" winner in the category of Culture Alignment
• DAV Patriot Employer
• VETS Indexes 4 Star Employer
• BBB Torch Award for Ethics from Better Business Bureau of Wisconsin

Role Snapshot
Our Case Management RN will work in our WPS Health Insurance business line. As a WPS Case Manager, your role will be to assist the member to navigate their healthcare journey by developing a care plan to coordinate care, provide benefits and network information, coordinate with providers, and provide member education and needed support.
In addition, you will have the opportunity to be crossed-trained in Utilization Management where you will become a thoughtful steward of our members healthcare benefits by evaluating the efficiency, appropriateness, and medical necessity of medical services, procedures, and facilities. This is done by reviewing evidence-based criteria and jurisdictional guidelines to make final determinations.
How do I know this opportunity is right for me? If you:

• Are a critical thinker who enjoys the challenge of identifying opportunities to refine and improve processes.
• Excel at identifying potential issues/problems before they come to fruition.
• Champion change and have a growth mindset.
• Are keeping current in medical knowledge and technical advances in the health care industry.
• Excel in problem solving and independent decision making.
• Excel at continuous learning and embrace learning new ways of performing work.
• Thrive in a production environment where quality and production metrics are critical to individual, team, and WPS success.
• Are familiar with MCG criteria and Care Management platforms (e.g., Medecision-Aerial) for cross training opportunity in Utilization Management.

What will I gain from this role?

• The opportunity to:
  
  • Cross train to Utilization Management (UM)
  • Further refine/develop Case Management programming
  • Partner with WPS Medical Directors
  • Help refine current processes by bringing your knowledge and expertise in Case Management forward.
• Exposure to a large variety of healthcare situations and medical conditions.
• Experience working for a company that serves our nation's military, veterans, Guard and Reserves, and Medicare beneficiaries.
• Working in a continuous performance feedback environment.

Minimum Qualifications

• Associate's or Bachelor's degree in Nursing
• 1 or more years of related work (e.g., Case Management) experience
• Active RN license, applicable to state of practice in good standing

Preferred Qualifications

• 5 or more years of experience in Case Management
• Utilization Management experience is a plus
• Complex Case Management experience
• Experience working with MCG or InterQual criteria
• Working knowledge of CPT/ICD 10/HCPCS codes
• Health insurance background in a Health Maintenance Organization (HMO), Point of Service (POS), Preferred Provider Organization (PPO), or Medicare Advantage (MA) plans

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer
• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)

Salary Range
$80,000 to $100,000
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.
Work Schedule

• Full-Time, Salaried
• Monday through Friday, Day Hours
• 2 openings

Work Location
We are a remote-first organization and offer remote work in the following approved states:
Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin
Benefits

• Remote work option available
• Performance bonus and/or merit increase opportunities
• 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs
• Review additional benefits here

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)