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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. Reviews and monitors daily inpatient stays per i Care's inpatient work processes and participates with
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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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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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This professional position is responsible for safely and effectively transitioning iCare members from acute inpatient care to home in a cost efficient manner. The Transition of Care Coach is accountable for integrating assessment, planning, implementation, coordination, monitoring, and evaluation of services for members into a streamlined, evidence based plan of care during the 30 day period post
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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. Completes a hospital follow up either telephonicall
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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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This position provides assistance and support to i Care members, staff, and providers to facilitate the provision of appropriate benefits for iCare members and evaluate and make recommendations regarding changes needed to improve care or its delivery. This position is also responsible for developing, implementing and evaluating outreach programs to promote positive health management and access to
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This professional position provides mental health and/or substance abuse intake assessments to iCare members being referred to the Specialty Services Department. The Intervention Specialist delivers short term, high intensity case management with the goals of providing member education and eliminating or improving non adherence to treatment. Conduct skilled assessments with identified members and
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This management position is responsible for i Care's Network Development strategy. Lead development of a strategic plan to meet i Care provider network business objectives, including the development and ongoing evaluation of the quality and adequacy of that network. Represent, communicate and advocate the i Care mission to current and/or prospective participants in the i Care provider network to e
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The position of the Customer Service Representative is intended to meet the needs of i Care members, potential enrollees and providers by providing a resource by phone, to answer member and provider inquiries related to benefits, eligibility and claims, coordinate/assist with member transportation needs, assist in care coordination by working with i Care staff, and perform other duties as assigned
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The Community Health Worker/Health Coach (CHW) will be responsible for helping members to navigate and access community services, other resources and adopt healthy behaviors. The CHW is an integral member of the interdisciplinary care management team. The CHW will work closely with designated iCare members, Care Coordinators, RNs, health care providers and community partners to effectively coordin
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The Community Health Worker/Health Coach (CHW) will be responsible for helping members to navigate and access community services, other resources and adopt healthy behaviors. The CHW is an integral member of the interdisciplinary care management team. The CHW will work closely with designated iCare members, Care Coordinators, RNs, health care providers and community partners to effectively coordin
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This professional position provides managed care coordination services to meet medical, behavioral health and social needs of Independent Care members while promoting and maintaining the quality of care for members. Conducts initial and annual assessments of members' medical, behavioral health and social needs to develop a care plan for each individual. The Care Coordination assessment is typicall
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