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This professional position is responsible for overseeing the disease management of members with chronic conditions (i.e. diabetes, COPD, or CHF). The RN Chronic Care Case Manager works with providers of health care and social services to meet identified complex and episodic medical and social needs of Independent Care members and to promote the efficient and cost effective delivery of health and s
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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, m
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This position provides case management and support to older adults in the Milwaukee County community, assuring quality services are provided which are cost effective and monitoring the heath and safety of members. Complete the nursing portion of the comprehensive assessment and provide input to the members care accordingly. Conduct home visits and community visits to assure appropriate care and ac
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Perform duties to support optimized performance on key quality indicators including, but not limited to, HEDIS, 5 Star, Pay for Performance (P4P), satisfaction surveys, Annual Quality Reviews (AQR), and External Quality Reviews (EQR). Apply continuous quality improvement strategies across all business lines to improve the quality of i Care's Medicare, Medicaid, and Long Term Care programs. The QAP
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A Provider Relations Representative serves as a liaison between iCare and providers. In that capacity, a Representative is responsible for providing customer service that requires analyzing and resolving various regulatory, billing and coding issues. The Representative will therefore be expected to use system applications, regulatory information, data and facts to solve a range of problems on beha
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This position serves as a liaison between iCare and provider community. In that capacity, the Provider Relations and Education Specialist is responsible for providing customer service that requires analyzing and resolving various regulatory, billing and coding issues. The Provider Relations and Education Specialist will therefore be expected to use system applications, regulatory information, data
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This professional position reviews the clinical appropriateness of prior authorization (PA) requests and ensures that all benefits authorized meet medical necessity and other Medicare and/or Medicaid criteria if applicable to promote cost effective delivery of health care services. Works with the Chief Medical Officer (CMO)/Medical Director to review PA requests, and ensures appropriate informatio
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This position will also serve as a clinical consultant to the i Care staff regarding Medicare and Medicaid guidelines, benefits and coverage issues relating to the prior authorization process. Supervise and direct the work of the all staff in the Prior Authorization Department. This includes hiring, training, handling employment and performance related matters, performance evaluations, coaching an
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Assist in the preparation, review and reconciliation of the encounter submissions to the various governmental agencies (State and Federal). Provide information necessary to assist the contracting department during rate negotiations and assist in the developing of standardized rates. Review Patient Protection and Affordable Care Act ("PPACA") distribution analysis received from the State of Wiscons
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