RN Case Manager – Denials and Appeals – Mon – Friday 8-4:30 – Waukesha Memorial Hospital – Waukesha, WI

Location: Waukesha

Job Type: Days – 1st Shift

Weekly Hours: 40

We Are Hiring: RN Case Manager, Denials and Appeals – Waukesha -1.0 FTE (Mon – Fri 8:00 – 4:30)

Begin your story with ProHealth Care. ProHealth Care was recognized in 2020 by Forbes as the best-in-state employer for Wisconsin. The award is a testament to the more than 5,000 employees and providers who have spoken up about their love for their jobs and the work that they do. Enjoy our video series featuring our own employees sharing why they choose ProHealth Care and what they enjoy about working here.

At ProHealth Care, we offer a culture that’s warm, welcoming, and vibrant. Additionally, we offer a generous benefits plan and resources to help you further your education. After all, it’s the way you should be treated.

Culture is built every day, and we want you to be a part of this. If you’re like us and are passionate about providing exceptional patient care, we’d like to meet you!

Schedule Details: Monday – Friday 8:00am – 4:30pm

As a member of the Care Management team, the Case Manager (CM) is responsible for facilitation of precertification and payor authorization processes and status determination at the point of entry in to the hospital from outpatient areas including 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 CM also facilitates collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement. RN CM’s actively participate in the discharge planning process for all patients working collaboratively with payors, providers, patients and families.

Ideal candidate possesses:

Excellent communication and negotiation skills

Strong analytical and computer skills with prior EPIC experience helpful

Experience with pre-acute and post-acute care, as well as, community based resources

Ability to work independently and collaboratively with the care providers and business office staff is necessary

Promotes safety, cost efficiency and a commitment to quality improvement.

What you will need:

Associate’s Degree in Nursing (BSN in nursing preferred)

Current Wisconsin RN license required

Current Basic Life Support (BLS) certification

Why Join ProHealth Care:

We have nearly 5,000 dedicated clinical and non-clinical employees and physicians who work together every day to serve the health and well-being of our community. At ProHealth Care everyone contributes to the care our patients receive. And, everyone is treated with kindness and respect in our welcoming environment.

This Position Will Offer You:

  • Engaging and community focused culture
  • Competitive Salaries
  • Opportunity for professional career growth
  • Robust benefits including: Generous PTO; Choices in insurance; HSA; Tuition reimbursement; immediate 401K match; discounted tickets to various entertainment, social and sporting events

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.

#CA *CA #LI

Here at ProHealth Care, we strive to be the best we can be, while continually improving the care we deliver. With patient care at the center of all we do, it is ingrained into our culture to attract the best and the brightest to ProHealth Care. We have a promise to our patients and employees: The way you should be treated. We live by this commitment and remain dedicated to creating a warm, safe and welcoming environment.

Nearest Major Market: Waukesha
Nearest Secondary Market: Milwaukee

Source: Indeed.com
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