Bachelor's Degree preferred
RN licensure required
- Seeking a professional Case Manager for Health Plan, Medical Management department.
- If you hold an Associate Degree in Nursing and are starting employment as a RN at Gundersen Lutheran, you would have 6 years after employment to obtain a Bachelor's Degree in Nursing.
The Case Manager will be responsible for identification, assessment, planning, implementing, coordination, monitoring and evaluation of patient care using the appropriate condition specific assessment tools and interventions within the managed care application. The Case Manager works in collaboration with the Provider, the member, member's family and other members of the health care team to assure the member's health care needs are met across the continuum of care and facilitates appropriate and timely benefit and treatment decisions.
- Required: Graduate of an accredited nursing program.
- Desired: B.S.N., Case Management
- Required: Minimum five years clinical experience with recent hospital experience.
- Desired: Previous experience in utilization management and knowledge of health insurance preferred.
- Required: Assessment and critical thinking skills. Analytical reasoning as demonstrated by the ability to identify problems, secure relevant information and determine potential solutions. Strong interpersonal communication (both written and verbal), and organizational skills. Current knowledge of professional nursing theory and practice. Competent use of Microsoft Word and databases.
- Desired: In addition to the above, knowledge of spreadsheet applications, knowledge of utilization review principles, medical necessity and level of care criteria, managed care principles, case management models and approaches, reimbursement systems and diagnostic and operative coding (ICD-9, HCPCS, and CPT).
- Required: Licensed to practice nursing within the State of Wisconsin
- Desired: Certified Care Manager (CCM), Certified Managed Care Nurse (CMCN) or Certified Professional Utilization Review (CPUR)
Gundersen Health System - 2 years ago