WPS Health Solutions
Case Management RN (Health Insurance) - Remote
This job is now closed
Job Description
- Req#: CASEM005605
Employer Industry: Health Insurance Provider
Why Consider this Job Opportunity:
- Salary up to $100,000
- Opportunity for career advancement and growth within the organization
- Remote work option available
- Performance bonus and/or merit increase opportunities
- Competitive benefits package including health insurance, dental insurance, and telehealth services
- Exposure to a variety of healthcare situations and medical conditions
What to Expect (Job Responsibilities):
- Develop care plans to coordinate care and provide benefits and network information
- Coordinate with providers and offer member education and support
- Evaluate the efficiency, appropriateness, and medical necessity of medical services
- Review evidence-based criteria and jurisdictional guidelines to make final determinations
- Cross-train in Utilization Management for further opportunities
What is Required (Qualifications):
- Associate’s or Bachelor’s degree in Nursing
- 1 or more years of related work experience in Case Management
- Active RN license, applicable to state of practice in good standing
How to Stand Out (Preferred Qualifications):
- 5 or more years of experience in Case Management
- Utilization Management experience
- 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
#HealthInsuranceProvider #CaseManagement #RemoteWorkOpportunity #CareerGrowth #CompetitivePay
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
WPS Health Solutions is still a leading not-for-profit health insurer in Wisconsin, and our services have grown to reach active-duty and retired military personnel, seniors, and families in Wisconsin, across the U.S., and around the world.
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