ProHealth Care has been the health care leader in Waukesha County and surrounding areas for the past century, providing outstanding care across a full spectrum of services. The people of ProHealth Care strive to continuously improve the health and well-being of the community by combining skill, compassion and innovation. The ProHealth family includes Waukesha Memorial Hospital, Oconomowoc Memorial Hospital, the Rehabilitation Hospital of Wisconsin, ProHealth Medical Group clinics, AngelsGrace Hospice, ProHealth Home Care & Hospice, West Wood Health & Fitness Center and Regency Senior Communities. Learn more at ProHealthCare.org
Hours: Routine business hours 08-1630 Monday- Friday with weekend rotation currently 1 W/E every 4-5 weeks
Full Time / Part Time: Full Time Benefits
As a member of the Care Management Team, the Case Manager is responsible for facilitation of precertification and payor authorization processes and status determination at the point of entry into the hospital from outpatient areas including the cath lab, day surgery and physician offices. This position will proactively prevent denials through assessment and application of Milliman Care guidelines to determine status for appropriate reimbursement and bed placement. RN also facilitates collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.
Ideal candidate possesses excellent interpersonal communication and negotiation skills. Stong analytical and PC skills. Experience with pre-acute and post-acute care as well as community resources. Ability to work independently and collaboratively with care providers and business office staff is necessary. Promotes safety, cost efficiency and a commitment to quality improvement.
The qualified candidate will possess the following:
- Bachelor's Degree in Nursing required.
- Current and valid State of WI Nursing license or ability to obtain within 90 days of hire
- Three or more years of strong clinical experience need
- Certification in case management preferred
- EPIC proficiency desirable
- Current working knowledge of utilization management,, discharge planning, case management, performance improvement and managed care reimbursement
ProHealth Care, one of the largest employers in Waukesha County, offers work that is challenging and rewarding. The organization is dedicated to providing the highest quality service to our patients and their families and treats each individual with respect – the way they should be treated. ProHealth Care supports a Just Culture, one that encourages an open learning environment and maintaining safe systems. We have high expectations for those who join our team of nearly 5,000 employees. In return, we offer exceptional career opportunities in a dynamic, health care system where the contributions of every team member are valued.
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ProHealth Care is an equal opportunity employer and is committed to an inclusive work environment and values the perspectives of our people. We maintain a drug-free workplace and perform pre-employment substance abuse testing. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.