Wisconsin Licensed RN Case Manager

Job Summary

Utilizing clinical expertise outside of a hospital setting, the full-time salaried Wisconsin Licensed RN Case Manager will review prior authorization requests, coordinate care transitions, and collaborate with healthcare providers to ensure optimal patient care, with options for in-person, hybrid, or remote work.

Key responsibilities

• Perform clinical reviews of prior authorization requests
• Conduct medical reviews for members requiring inpatient, skilled nursing facility, and home health services
• Communicate with members, caregivers, and providers regarding medical reviews and care coordination

Required qualifications

• Bachelor's Degree in nursing or an Associate's Degree with relevant experience
• Unrestricted State of Wisconsin RN license (Compact State License acceptable)
• 2+ years of RN utilization management experience preferred
• Insurance or managed care experience preferred
• Valid State of Wisconsin driver's license required; some travel within service area