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RN Case Manager

    • Job Tracking ID: 512689-606721
    • Job Location: Milwaukee, WI
    • Job Level: Mid Career (2+ years)
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: April 20, 2018
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
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Job Description:

Summary:

This professional position works with providers of health care, behavioral health and social services to meet identified complex and episodic medical, psychiatric and social needs of Independent Care members, and to promote the efficient and cost-effective delivery of health and social services.

Essential Duties and Responsibilities:

  1. Assists Care Coordinators/Care Managers in the development and oversight of care plans and prioritization of complex medical, behavioral health and social needs.
  2. Assists in completion of initial and annual assessments as requested.
  3. Reviews, monitors and updates care plans as needed.
  4. Monitors and directs members to appropriate specialty services and alternative treatment settings.
  5. Consult regarding prior authorization (PA) requests for medical necessity and recommendations for home health services, durable medical equipment and therapies.
  6. Consult with utilization review staff regarding inpatient stays per iCare’s inpatient work processes and participates with facility discharge planners, Care Coordinators/Care Managers and the behavioral health personnel in coordinating the member’s discharge needs.
  7. Coordinates services, communicates information, and interfaces with health care providers regarding the management of member’s current medical, behavioral health and social needs.
  8. Interprets and administers benefits in accordance with regulatory and contractual requirements and medical management guidelines.
  9. Keeps CC/CM informed on members&rsquo: current problems/diagnoses.
  10. Actively problem solves with staff, members and providers in finding alternatives or solutions to their medical, behavioral health and social needs.
  11. Assists Care Coordinators/Care Managers and behavioral health personnel in completing home visits as necessary.
  12. Produces and submits reports per iCare’s work processes and guidelines.
  13. Provides accurate and timely documentation per iCare’s work processes and guidelines.
  14. Contributes to interdisciplinary iCare team meetings as either a participant or a facilitator.
  15. Practices and promotes safety in the workplace.
  16. Acts as a resource for iCare staff and assists with training employees.

 

Experience and Skills:

  1. Must be a Registered Nurse, licensed in the State of Wisconsin.
  2. Requires at least two years of related health care 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 co-workers 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 the Milwaukee metropolitan area.
  10. Ability to use a personal computer and capability of learning software applications of Independent Care.
  11. Ability to work independently with minimal supervision.
  12. Case Management skills to determine appropriateness of member’s care.
  13. Maintain confidentiality regarding Independent Care and its member information.

Benefits

$5,000 New Hire Bonus!


 

 
 
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
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  • Copyright © 2017 Independent Care Health Plan