Supervisor of Health Services

Overview

Role:
Health Services Supervisor. The Health Services Supervisor is responsible for overseeing the Health Services Utilization and Case Management nursing teams, managing inventory, supporting staff mentoring and training, and driving workflow efficiencies within the teams. Works closely with the Health Services Manager and supports the implementation of departmental and company initiatives while serving as a key daily resource for the nursing teams.

Salary Range: $95,000 ~ $115,000. The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

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) will be expected to be able to work onsite 2 days a week on a regular basis.

• Ensure utilization management reviews are completed in accordance with department standards.
• Coach and mentor nursing staff conducting medical necessity reviews, prior authorizations, and appeals.
• Oversee case management activities to ensure timely and appropriate member interventions to meet individual needs and maximize health outcomes.
• Collaborate with physicians, providers, and internal departments to coordinate care for complex cases.
• Monitor team performance, productivity, quality of care, and compliance with established metrics and accreditation standards (e.g., URAC, NCQA).
• Provide training and professional development opportunities for nursing staff.
• Serve as a clinical resource for staff, handling escalated provider and member inquiries.
• Conduct staff quality audits and support the development of clinical guidelines and utilization review protocols.
• Participate in quality improvement initiatives and contribute to the development of department goals and performance targets.
• Assist with system testing, configuration, training, and implementation of new systems or upgrades.

• Registered Nurse (RN) with current licensure in the state of Wisconsin OR current Compact License.
• Active RN license, applicable to state of practice in good standing.
• Associates 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, including:
• Excellent reading comprehension, written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.
• Proficient in Microsoft Office tools with 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 Third party Administration (TPA) Point of Service (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 (can be checked at )

• 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:

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…