Live In Cigna Utilization Review Nurse Jobs in Appleton, WI

Description

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This is a float position primarily within Waushara County, potential travel up to 2 hours within the service region.

The RN Care Manager, as part of an interdisciplinary team (IDT), serves frail elders, adults with physical disabilities and adults with intellectual/developmental disabilities who are members of Lakeland Care, Inc. (LCI). The team's goal is to promote the overall well-being of the members LCI serves by providing high quality, person-centered, outcome-based care.

Under general direction of the Care Management Supervisor, this position provides care management and service coordination to LCI members. As a member of the IDT, the RN Care Manager (RNCM) arranges for provision of services and supports based on a comprehensive assessment of the member's identified outcomes and needs. The IDT staff monitors the provision of services based on the member-centered plan per LCI policy and procedures, and Department of Health Services (DHS) contract requirements.

Essential Competencies:

• As part of an interdisciplinary team (which also includes a care manager and the member and/or legal representative), the RNCM conducts a comprehensive assessment of the member's outcomes, needs and risks; and reassesses as the member's outcomes and/or condition changes.
• Coordinate acute and primary care services, care transitions and related follow-up care.
• Develop, coordinate, monitor, and evaluate members' outcome-based member-centered plans, considering cost and effectiveness in authorizing services and choosing providers.
• Promote prevention and wellness by incorporating preventative, supportive, restorative, and rehabilitative care into the care planning process.
• In collaboration with the Care Manager (CM), implement risk mitigation strategies to promote the member's health, safety and independence while respecting the member's rights.
• Participate in on-going training to maintain current knowledge to ensure compliance with Federal and State regulations, LCI policy and procedure and accepted professional standards.
• Create and maintain member records as required by the Department of Health Services (DHS) contract and LCI policy. 
• Participate in, via face-to-face, in-home visits and care conferences involving the member, their supports, and providers to assess, reassess, and address health and medically related needs.
• Participate in the 24-hour on-call rotation as necessary.
• Participate in team meetings and internal workgroups as required/requested.
• Provide nursing care in accordance with the Nurse Practice Act.
• Maintain the confidentiality of member information and protected health information (PHI) as required by State and Federal regulations, including the Health Insurance Portability and Accountability Act (HIPAA) of 1996.  

Requirements

• Current License to practice as a Registered Nurse in the State of Wisconsin.
• Bachelor's degree in nursing strongly preferred.
• Two (2) or more years of skilled nursing experience preferred, ideally in gerontology/disabilities and/or home care.
• Ability to access members' homes which are not required to comply with the ADA regulations.
• Ability to lift up to 25lbs.
• Current driver's license, acceptable driving record and proof of adequate insurance.

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Lakeland Care is a Wisconsin-based non-profit organization that focuses on creating a world we all want to live in.  With long standing roots as a managed care organization (MCO), we provide long-term care services to eligible elders and individuals with physical and intellectual or developmental disabilities.  

Our Mission

Empowering Individuals.  Strengthening Communities.  Inspiring Futures.

Our Vision

To create a world we all want to live in.

Our Core Values

Kindness. Inclusion. Trust.

We are an equal employment opportunity employer functioning under an Affirmative Action Plan. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.  We are an organization that practices in E-Verify.