WI3643770

1

Vocational Degree

Associate Degree

Unspecified

40

JOB REQUIREMENTS: Description Who We Are 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 . 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: 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\... For full info follow application link. Wisconsin
Physicians Service Insurance Corporation is an Equal Opportunity
Employer/Protected Veterans/Individuals with Disabilities employer.
\*\*\*\*\* APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/2FF79942A19B4983 Qualified females, minorities, and special
disabled veterans and other veterans are encouraged to apply.