Registered Nurse - Case Management in Kansas City, MO

Role Overview As a Registered Nurse specializing in Case Management, you will play a pivotal role in coordinating care for member populations with complex health care needs across various settings. Your primary objective will be to create and consistently update a personalized care plan that emphasizes effective utilization of health care 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 liaison 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 the following states: 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 tailored 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, such as 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 recognize and address obstacles to care. • Are skilled in coordinating medical services and resources, facilitating 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 aid 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 cases that involve high risk, cost, or utilization. • Have maintained precise, up-to-date case notes, care plans, and documentation in compliance with health plan guidelines and regulatory standards. • Can collaborate with various departments to support overall operational efficiency, quality, 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 in diverse clinical settings (e.g., hospital, clinic, home care, skilled nursing facility). • At least 2 years of direct case management experience. • Proven ability to manage and coordinate care effectively 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 independent work capability, effective case load management, and strong prioritization skills. • 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 in 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, which allow 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.