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RN Case Manager - Badger Care Plus

    • Job Tracking ID: 512689-619005
    • Job Location: Milwaukee, WI
    • Job Level: Mid Career (2+ years)
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: May 01, 2018
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
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Job Description:

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 BadgerCare members, and to promote the efficient and cost-effective delivery of health and social services. This position reports to a Manager of Care Management.

Primary Responsibilities:

Reviews prior authorization (PA) requests for medical necessity and recommendations for home health services, durable medical equipment and therapies per iCare’s PA work processes.

Monitors and directs members to appropriate specialty services and alternative treatment settings.

Reviews and monitors daily inpatient stays per iCare‘s inpatient work processes and participates with the facility discharge planners, and behavioral health personnel in coordination members discharge needs.

Coordinates services, communicates information and interfaces with health care providers regarding the management of members’ current medical, behavioral health and social needs.

Interprets and administers benefits in accordance with regulatory and contractual requirements and medical management guidelines.

Actively problem solves with staff, members, and providers in finding alternatives or solutions to their medical, behavioral health and social needs.

Produces and submits reports per iCare’s work processes and guidelines.

Provides accurate and timely documentation per i-Care’s processes and guidelines.

Develop and execute care management plans including short and long term goals for patients with specific disease processes which require additional services to assist member reach health related goals and proper utilization.

 

 

Experience and Skills:

Required Qualifications:

Must be Registered Nurse in the State of Wisconsin with no restrictions on license.

Requires at least two years of related health care experience.

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

Ability to effectively communicate in writing and understand written materials of a complicated nature.

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

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.

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

Problem solving ability to seek solutions using appropriate methodologies.

Must be able to travel to any location within MilwaukeeCounty.

Benefits

  • $5000 Sign-On Bonus
  • No Holidays or Weekends

 


 

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