Supervisor of Health Services - CM, UM

Role Snapshot

Health Services Supervisor oversees the Health Services Utilization and Case Management nursing teams. The supervisor manages inventory, supports staff mentoring and training, and drives workflow efficiencies within the teams. The role works closely with the Health Services Manager and supports implementation of departmental and company initiatives while serving as a key daily resource for the nursing teams.

$95,000 ~ $115,000 (base pay may vary within this range based on job-related knowledge, skills, and experience).

Remote work is open to 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, Madison, WI) must work onsite 2 days a week on a regular basis.

• Can ensure utilization management reviews are completed in accordance with department standards.
• Enjoy coaching and mentoring nursing staff conducting medical necessity reviews, prior authorizations, and appeals.
• Have overseen case management activities to ensure timely and appropriate member interventions to meet individual needs and maximize health outcomes.
• Can collaborate with physicians, providers, and internal departments to coordinate care for complex cases.
• Would enjoy monitoring team performance, productivity, quality of care and compliance with established metrics and accreditation standards (e.g., URAC, NCQA).
• Like providing training and professional development opportunities for nursing staff.
• Can serve as a clinical resource for staff, handling escalated provider and member inquiries.
• Would like to conduct staff quality audits and support the development of clinical guidelines and utilization review protocols.
• Have participated in quality improvement initiatives and contributed to the development of department goals and performance targets.
• Would be able to assist with system testing, configuration, training, and implementation of new systems or upgrades.

• Registered Nurse (RN) with current licensure in Wisconsin or a current Compact License.
• Active RN license in good standing.
• Associate’s Degree in Nursing.
• 5 or more years of clinical experience in a healthcare setting (hospital, clinic, home care, skilled nursing facility, etc.).
• Solid knowledge and understanding of medical/clinical review processes.
• Strong analytical, problem‑solving, and organizational skills with the ability to manage multiple cases simultaneously and meet strict deadlines. This includes:
  • Excellent reading comprehension, written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.
  • Proficiency in Microsoft Office tools and experience working in electronic health records.

• 1 or more years of experience in a supervisory or leadership role.
• Bachelor’s degree in nursing (BSN).
• Certified Managed Care Nurse (CMCN).
• Health insurance background that could include TPA, POS, PPO, or Medicare Supplement plans.

• High‑speed cable or fiber internet.
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection.
• Review Remote Worker FAQs for additional information.

• Remote and hybrid work options available.
• Performance bonus and/or merit increase opportunities.
• 401(k) with a 100% match for the first 3 percent of your salary and a 50% match for the next 2 percent (100% vested immediately).
• Competitive paid time off.
• Health insurance, dental insurance, and telehealth services start DAY 1.
• Professional and Leadership Development Programs.
• Additional benefits details available at the provided link.

WPS is a health solutions company, 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’s culture fosters innovation and rewards high‑performing teams. We create an open and empowering employee experience, encouraging engagement and diverse perspectives to fuel agility and innovation. This results in people bringing their authentic selves to work daily, enabling the organization to adapt quickly to business changes and new opportunities.