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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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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 disch
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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 position provides case management and support to older adults in the Kenosha, Racine and Southern Milwaukee County communities, 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
Posted Today
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 part time professional position is responsible for oversight of the utilization management, credentialing, and quality management functions. Provides medical expertise and acts as senior medical resource for review of complex medical and social cases. Acts as primary liaison with physicians. This position reports to the Chief Medical Officer. Assist in the development of ongoing quality impro
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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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As a critical member of the Family Care Partnership program the dedicated Functional Screener is responsible for completing the LTCFS (Long Term Care Functional Screens) for Independent Care Health Plan (iCare) members, as required and outlined in the Wisconsin LTCFS Instructions. This includes annual rescreens, change in condition screens, collateral contacts, and verifying diagnoses with physici
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Master's Degree in Nursing. Possession of a licensure or eligibility for licensure in the State of Wisconsin as a Registered Nurse, Advance Practice Nurse Prescriber (APNP) licensure, and national NP certification in geriatrics, adult or family practice. Strong assessment and care planning skills required along with the ability to provide complex care coordination. Ability to effectively communica
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