Insurance Case Manager Jobs in Wisconsin (NOW HIRING)

At Children's Wisconsin, we believe kids deserve the best.

Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.

We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.

Please follow this link for a closer look at what it's like to work at Children's Wisconsin:https://www.instagram.com/lifeatcw/

Job Summary:
Utilizing the case management process, the Integrated Case Manager the (ICM) coordinates transitional care for the children/families for an assigned medical team. Responsible for effective coordination of care, the ICM collaborates with providers to assure all patient stays meet the needs of the patient to discharge in a safe and efficient manner. In addition, based on the needs of the department also performs the functions of a Hospital Case Manager (HCM).
Essential Functions:

• Understands and satisfies the continued needs of the neonate, infant, toddler, pre-school, school-age, adolescent and/or young adult patient in regard to their growth and development as they transition home or to an alternate level of care.
• Demonstrates teamwork within the department by assisting other staff members as necessary.
• Integrated Case Manager * Initial and ongoing assessment of the patient's clinical situation and inclusive of their physical and behavioral needs. * Leads the implementation and management of a care coordination plan by collaborating with members of the care coordination team, family/care givers, treating providers, hospitals and other facilities, community agencies and services. Attends all patient rounds with assigned Provider teams. Documents all acute care admissions as avoidable potential denials when InterQual criteria are not met. * Documents all length of stay concerns as avoidable potential denials. * Collaborates with Providers on the attending team to discuss differences in LOC assignment. Uses clinical protocols, algorithms, paths, if available and applicable. * Ensures that patients receive appropriate services across the continuum of care and continuity of care across service levels and among providers. * Provides or arranges outreach calls or visits to patients to insure appropriate delivery and access to aftercare services. * Communicates self-pays and out-of network payors to financial clearance department. * Provide education to families about outpatient/observation level of care and potential co pays.
• Hospital Case Manager * Performs all the functions of the Hospital

Education:

• Associate's Degree Nursing required
• Bachelor's Degree Nursing preferred

Experience:

• 2+ years Minimum of 2-3 years of case management experience preferred
• Previous experience in pediatrics, discharge planning, home care, and/or other care of the child/family preferred

Knowledge, Skills and Abilities:

• Independent judgment, analytical ability, systems thinking and highest level of interpersonal communications to work effectively in complex systems.
• Able to collect pertinent clinical information while maintaining a good rapport and relationship with providers.
• Considerable skill in interpreting clinical treatment information resulting in successful linking of patients with providers and resources throughout the continuum of care.
• Expertise in Utilization Management and understanding of InterQual criteria preferred.
• Computer knowledge and skills in WORD, Outlook, Excel and Internet use.
• Ability to learn and navigate hospital specific programs such as Origami,Epic and Electronic Health Records.
• An understanding of the impact of healthcare delivery systems on the patient and family.
• Knowledge of patient care, case management theory and practice preferred.

Licenses and Certifications:

• License RN-Registered Nurse (30) - State of Wisconsin required
• ANCC certification or CCM-Certified Case Manager - Commission for Case Manager Certification preferred

Patient Care Responsibility:

• Provides care appropriate to patient population and as described in applicable policies and procedures.

Required for All Jobs:

• This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job.
• Employment is at-will. This document does not create an employment contract, implied or otherwise.

Hours: 8A-4:30

Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

Certifications/Licenses: