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. This position works specifically with the Maternal Child Health population.
- Assists Care Coordinators/Care Managers in the development and oversight of care plans and prioritization of complex medical, behavioral health and social needs of the Maternal Child Health population.
- Provides health focused education to all members with focus on teaching self-advocacy and simple easy-to-follow understanding of their medical conditions, medications, and treatment plan.
- Reviews, monitors and updates care plans for medically complex members at all stages of life including newborn, pediatric, prenatal, postpartum, and caretakers.
- Provides care coordination to all pregnant and postpartum members enrolled in the OB Medical Home sites.
- Monitors and directs members to appropriate specialty services and alternative treatment settings. Utilizes community resources.
- Contributes to policy/procedure/program development for BC+.
- Involved in program development to improve state-wide P4P measures and PIP.
- Consult regarding prior authorization (PA) requests for medical necessity and recommendations for home health services, durable medical equipment and therapies.
- 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.
- Coordinates services, communicates information, and interfaces with health care providers regarding the management of member’s current medical, behavioral health and social needs.
- Interprets and administers benefits in accordance with regulatory and contractual requirements and medical management guidelines. Completes record review and creates individualized, comprehensive care plan for all members in need of case management based on medium risk level policy. Care Plan is closely followed and adjusted as appropriate based on changes in condition. Once health is stable, care is transitioned appropriately. RNCM keeps CC/CM informed on members’ current problems/diagnoses.
- Actively problem solves with staff, members and providers in finding alternatives or solutions to their medical, behavioral health and social needs.
- Must be a Registered Nurse, licensed in the State of Wisconsin.
- Requires at least two years of related health care experience in maternal and child health.
- A personal vehicle, valid State of Wisconsin motor vehicle operator’s license and conformity with insurance coverage limits are required.
- Ability to effectively communicate thoughts, ideas, and information both orally and in writing.
- 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 the Milwaukee metropolitan area.
- Ability to use a personal computer and capability of learning software applications of Independent Care.
- Ability to work independently with minimal supervision.
- Case Management skills to determine appropriateness of member’s care.
From: iCare Independent Care Health Plan