RN Care Manager - Dual Eligible Plans

Founded in 1982, Network Health is locally owned by Froedtert ThedaCare Health and is the largest provider-owned Medicare Advantage plan in Wisconsin, serving both employer groups and individuals. We collaborate with our provider-owners to give members access to high-quality coordinated care. When you call us, we don’t bombard you with health insurance jargon. We talk like people, not insurance dictionaries. Being local allows us to focus on our mission of creating healthy and strong Wisconsin communities. We care about making our home a better place to live. In 2026, Network Health Medicare Advantage PPO plans earned a 5 Star Rating for customer service for the fifth consecutive year. For 2026, Network Health earned an overall 4.5 out of 5 Star Rating for its Medicare Advantage Prescription Drug PPO plans from the Centers for Medicare & Medicaid Services (CMS).

The Registered Nurse Care Manager provides case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across the healthcare continuum. The Care Manager advocates for options and services to meet an individual’s and family’s comprehensive health needs through communication and coordination of available resources to promote quality, cost-effective outcomes. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Screen candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes for re-assessment using evidence-based clinical guidelines. Evaluate and determine member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies Review results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; close cases when expected goals/outcomes are achieved Provide information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff Evaluate and process member referrals from physicians to other specialty providers Assess, plan, facilitate and advocate for individuals to identify quality, cost effective interventions services and resources to ensure health needs are met Works with members and families on self-management approaches using coaching techniques such as motivational interviewing Educate the individual, his/her family and caretakers about case and condition management, the individual’s health condition(s), medications, provider and community resources and insurance benefits to support quality, cost effective health outcomes. Facilitate the coordination, communication and collaboration of the individual’s care among his/her providers including tertiary, non-plan providers and community resources with the goal of controlling costs and improving quality. Schedule visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning. Stay abreast of current best practices and new developments Other duties as assigned