Remote Operations Manager Jobs in Madison, WI (NOW HIRING)

Our Manager of Case Management & Intake provides leadership and oversight for the case management clinical team and non-clinical Intake team within our Health Plan. This Manager coordinates patient care programs, ensures quality service delivery and manages staff performance and departmental operations. They develop, implement and monitor case management programs, and intake and discharge planning. This Manager of Case Management & Intake collaborates with other Health Services teams to ensure seamless interdepartmental coordination of services. They identify opportunities for improvement of workflows, executes initiatives, is a key resource for internal departments and represents Health Services on cross-functional projects.

Salary Range
$110,000 ~ $130,000
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, experience and may fall outside of this range.

We are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
Employees living within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI, 53713) will be expected to be able to come into the office 2 days a week on a regular basis.

How do I know this opportunity is right for me?  If you:

• Enjoy providing day-to-day managerial direction, leadership, and oversight of Case Management clinical staff and non-clinical Intake teams ensuring compliance with all corporate and departmental policies, procedures, work standards, and strategies.
• Can oversee clinical functions, provide direction to clinical staff and serve as subject matter expert for questions and difficult case reviews.
• Like to develop, analyze and maintain staff daily/weekly production and compliance.
• Have ensured CM and Intake production and quality standards are met.
• Work closely with the intake supervisor to monitor department needs and volume of incoming requests.
• Thrive while collaborating cross-functionally to develop and implement new Health Services programs and strategies.
• Have developed and revised Health Services policies, procedures, and guidelines that direct department processes, continually evaluating to optimize efficiency within departments.
• Enjoy evaluating, analyzing, reporting, and responding to case management trends in health care delivery areas.
• Are able to recommend and implement changes consistent with Health Services objectives of quality care and reasonable cost.
• Can represent Health Services on committees and work groups for various intradepartmental presentations related to Case Management and Intake.
• Wan to oversee the maintenance of documentation for internal and vendor authorization processes. Assist with configuration, training and implementation of systems (Aerial, Facets, etc.).

Minimum Qualifications

• Bachelor’s degree in Nursing or equivalent combination of education and experience; including CCM certification.
• Active license as an RN in the State of Wisconsin or a valid multi-state compact license.
• 7 or more years of clinical nursing experience.
• 3 or more years in a senior level or managerial role in managed care Case Management.
• Strong knowledge and understanding of clinical operations, case management and intake processes and procedures.
• Knowledge of current medical practices, trends, and patterns of care.
• Experience with accreditation standards (e.g., URAC) and regulatory compliance.
• Ability to plan, coordinate, implement, and manage projects in a timely and accurate manner.
• Strong analytical, problem-solving, and communication skills.
• Proficiency with Microsoft Office and clinical systems (e.g., imaging and review platforms).

 Preferred Qualifications

• 5 or more years in a senior level or managerial role in managed care Case Management.
• Familiarity with health plan operations, payer/provider relationships, and insurance benefits.
• Health insurance background in Point of Service (POS), Preferred Provider Organization (PPO), or Medicare Supplement) plans.
• Technical experience with word processing, spreadsheets, and proficiency with electronic medical record (EMR) systems and/or other managed care software.

 Remote Work Requirements

• High speed cable or fiber
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net).
• Please review Remote Worker FAQs for additional information.

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs
•  Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, 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 has been making healthcare easier for the people we serve for nearly 80 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 open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique 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.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace:  WPS Newsroom - Awards and Recognition.

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