DescriptioniCare is seeking a Wisconsin Interdisciplinary Care Team (WICT) RN Care Manager who works within the team to meet identified complex and episodic medical, behavioral and social needs of members, and promotes the efficient and cost-effective delivery of health and social services.ResponsibilitiesThe WICT RN Care Manager identifies appropriate medical needs, interventions and referral sources for members referred to the WICT team and facilitates their implementation in alignments with the overall care plan for the member. This role actively problem solves with staff, members, and providers in finding alternatives or solutions to their medical, behavioral health and social needs.Essential Duties and Responsibilities:Perform all duties in alignment with the DHS contract for Medicaid Managed Care Organizations, specifically regarding the Wisconsin Interdisciplinary Care Team (WICT).
Tailor assessments and interventions according to the member's level of engagement, activation and with consideration of the member's priorities.
Assists with the oversight of care plans and prioritization of complex medical, behavioral health and social needs.
Coordinates services, communicates information, and interfaces with health care providers and community supports regarding the management of member's current medical, behavioral health and social needs.
Acts in accordance with the nursing scope of practice and role within the interdisciplinary team. Concurrently, have an understanding and appreciation of the role and scope of practice of the other disciplines on the team to maximize effective collaboration in meeting the member's needs.
Conduct visits in the community to complete face-to-face requirements with identified members and assist in developing care plans with a focus on medical needs.
Participates and contributes to regular member staffing meetings to keep the team informed of updates to the care plan, collectively problem solve and determine the enrollment/graduation of members.
Serves as a consultative resource for other care management staff.
Interprets and administers benefits in accordance with regulatory and contractual requirements and medical management guidelines.
Provides accurate and timely documentation per i Care's work processes and guidelines.
Required QualificationsMust be a Registered Nurse, licensed in the State of Wisconsin.
Two (2) years of related health care experience.
Experience or a proficient knowledge-base in chronic disease management.
This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
This role is a part of Humana's Driver Safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
Must have the ability to provide a high speed DSL or cable modem for a home office.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Must be able to travel to any location within member service area.
Preferred QualificationsPrevious Case Management experience.
General knowledge of Medicare and Medicaid benefits.
Additional InformationWorkstyle : Hybrid Home. Hybrid Home is defined as 1 - 2 days/week in one of Humana's or iCare's WI office locations and 3 - 4 days remotely.
Travel: up to 10%
Interview FormatAs part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.Scheduled Weekly Hours40Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.