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Readmission Prevention Case Manager

    • Job Tracking ID: 512689-598544
    • Job Location: Milwaukee, WI
    • Job Level: Mid Career (2+ years)
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: December 05, 2017
    • Years of Experience: 5 - 7 Years
    • Starting Date: ASAP
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Job Description:

This professional position is responsible for assisting with safely and effectively transitioning iCare members from acute inpatient care to home in a cost efficient manner. The Readmission Prevention CM is accountable for creating and ensuring that members adhere to an evidence based plan of care during the 30 day period post hospital discharge.

 

  1. Completes a hospital follow up either telephonically  within 48 business hours or in home within 72 business hours of hospital discharge notification with emphasis on:

  2. In conjunction with the iCare Transition of Care Coach, develops a member centered plan of care and enforces identified interventions during the 30 day period post discharge. 

  3. Conducts subsequent telephonic follow up based on members risk level.

  4. Coordinates necessary services with ancillary providers and community agencies as appropriate to ensure member stabilization within the home.

  5. Assists the iCare RN Discharge Planner in completing the Care Plan Transition Form to ensure delivery to the usual practitioner within 72 hours of discharge notification.

  6. Promotes active and ongoing engagement of members and family caregivers with a focus on goal achievement.

  7. Collaborates with the multidisciplinary team across episodes of acute care and facilitates communication between and among the member, family caregivers, and health care providers.

  8. Reviews and updates plan of care and expedites modifications including newly identified barriers to adherence.

  9. Maintains active caseload.

  10. Provides information to members and providers regarding benefits, service providers and access protocols and educates members on appropriate use of medical services. Provides referrals for community resources and social services as necessary.

  11. Documents member information and contacts made regarding member’s care and services provided.

  12. Actively monitors member’s ability and willingness to engage in treatment regimes, and problem solves with staff, members and providers, alternatives or solutions to their needs.

Experience and Skills:

  1. Bachelor’s degree in social service, rehabilitation, psychology or other related degree.

  2. Related health care or social work experience.

  3. A personal vehicle, valid State of Wisconsin motor vehicle operator’s license and conformity with insurance coverage limits are required.

  4. Ability to effectively communicate thoughts, ideas, and information both orally and in writing.

  5. Ability to demonstrate flexibility, set priorities with daily demands and long-term work assignments and projects.

  6. Strong interpersonal skills and ability to effectively interact with members and coworkers from a variety of different backgrounds and experiences in a professional and courteous manner.

  7. Ability to work effectively as a team member and cooperate in achieving company goals.

  8. Problem solving ability to seek solutions using appropriate methodologies.

  9. Must be able to travel to any location within Milwaukee County.

  10. Ability to use a personal computer and capability of learning software applications of Independent Care.


 

 
 
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
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