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This position is responsible for designing, developing, implementing, and verifying solutions for i Care's claims process, care management, finance and analytics areas. Understands scope, requirements, and business cases in developing solutions estimates, and design overviews by using strong interviewing and communications skills. Develops technical designs, detailed interaction diagrams, componen
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Coordinate various administrative expense budget functions, including the annual company budget, Medicare SNP bid projections and multi year administrative expense projections for product proposals/renewals. Generate and distribute monthly actual vs. budget expense variance reports to department heads and ensure understanding of reports, reasons for variances, etc. Responsible for cost allocation
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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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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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Develops the i Care's provider network education materials and tools to best serve the needs of i Care. Develops communication strategy, material and tools to ensure i Care's provider community remains well informed of changes. Develops, in collaboration with iCare leadership and staff, strategies to engage providers around iCare goals for improvement in quality and service to members. Develops co
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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 effectively and efficiently develops and maintains a network of contracted providers to meet the needs for iCare membership and lines of business. Develops the iCare's provider network to best serve the needs of iCare enrollees. Works in collaboration with internal staff to complete and periodically update market analyses to determine network adequacy and identify network development
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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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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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This professional position assists the Vice President & General Counsel with various legal and internal auditing responsibilities. Provides paraprofessional legal support to and administration of routine legal related matters and projects. Work includes internal auditing of i Care's Compliance program to ensure alignment with federal requirements, maintaining certain contract databases, legal rese
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This position is responsible for providing leadership to the Family Care Partnership (FCP) program. The Clinical Practice Manager and the Program Manager are jointly responsible for ensuring a high performing, fiscally responsible, and contract compliant FCP program. Direct, supervise, hire, and evaluate or ensure the completion of these tasks regarding the performance of the Nurse Practitioner te
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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 typically conducted in the member's home, office or other community setting. Coordinates and organizes information about members' medical, behavioral health and social needs based on an assessment. Develops a formal care pla
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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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