This is a full-time position with a hybrid remote work arrangement in our Sheboygan, WI location. No weekends, holidays or on-call rotations.
Prairie States Enterprises, Inc. is a third party administrator, a benefits industry leader, and a trusted advisor to self-insured companies and their employees. We provide a complete range of medical benefit management services, all performed in-house, and to exacting standards of excellence.
As a result of our continuing growth, we are seeking an experienced RN to join our PSE Health Management Team in the position of a Complex Case Management RN. We seek professionalswho share our passion in striving to improve the health status and benefit plan experience of our clients and their employees.
The role of the Complex Case Management RN demonstrates competency in the concepts, principals, strategies, and application of CM practices. The Complex Case Management RN will assist Case Manager II’s with telephonic out-reach to actual and potential high risk member’s in the Prairie States (PSE) book of business that have been identified through the Acuity Health Management System or through the Prairie States claims department. The Complex Case Management RN position requires minimal direction and is responsible for assuring that members have access to quality, cost effective health care, and to assist in the assessment, development, and coordination of a proactive plan in order to ensure the best outcome for their particular condition.
SUMMARY OF ESSENTIAL JOB FUNCTIONS
• Initiate telephonic contact to assess member’s current health status
• Identify gaps of barriers in treatment plans
• Provide patient education to assist with self-management
• Interact and make referrals to Optimal Health or Disease Management
• Coordinating care or services as needed
• Documenting and tracking findings
• Report proactive saving created with Case Management (CM) intervention(s)
• Making “Welcome Home” calls to ensure discharged members receive the necessary services and resources (medications, follow-up appointments, etc.)
• Establishes trust and introduces the Case Management program
• Effectively manages personal caseload while maintaining billing standards
• Develop and implement short term goals and Care Plans in collaboration with all areas in the Health Services Department
• Identify and present complex cases to CM II’s utilizing sound clinical judgment
• Collaborates with Inpatient Case Manager when member is hospitalized
• Other duties as requested or assigned
• Education –BSN degree required; RN current licensure in good standing
• Effective communication skills including oral, nonverbal and written
• Ability to work collaboratively with the Health Services team and other PSE departments
• Ability to manage an independent case load
• Strong organizational skills
• Strong sense of customer service
• Ability to work with diverse individuals
• Adherence to and application of HIPAA regulations
• Experience – 3 years in a clinical or hospital setting. Case Management is a plus
• Computer Skills: Word, Excel, Microsoft Outlook, keyboarding and data entry
• Experience in utilization review, concurrent review and /or discharge planning
• Professional telephone etiquette - Must be able to carry on conversations with medical providers, and members to facilitate good understanding by all parties
• Change Management – Accepts, supports, and executes assignments in conditions of change which support attaining department goals.
• Effective Communication – Demonstrates effective and responsive communications following the appropriate reporting structure.
• Accountability/Results – Achieves and/or exceeds result based goals that were specific, measurable, and timely.
• Teamwork – Demonstrates teamwork behaviors and makes positive contributions and which support the achievement of department goals.
• Customer Satisfaction – Dedicated to the PSE service model and meets or exceeds PSE customer satisfaction expectations in providing exemplary service.
• Professional Growth – Takes ownership of one’s professional growth within one’s current position and to advancement at PSE.
This is sedentary position which requires the individual to sit for long periods of time and the proper positioning/posturing for extensive viewing of computer screens and computer related work is required. It is encouraged that individuals intermix this sedentary time with periodic movement within one’s office space and/or to other office areas to counteract the sedentary nature of this position.
To the selected candidate, we offer:
Competitive compensation based on experience and a comprehensive benefit package provided to include Medical, Dental, Vision, Life, Short-Term Disability (STD) /Long-Term Disability (LTD), flexible spending, Paid Time Off (PTO), paid holidays, 401k with match, wellness and exercise membership and more. Click HERE to view our full-time benefits flyer.
Opportunity for meaningful career growth within a results-driven company and our company culture is one of ambition, integrity, empowerment, teamwork and a passion for personal and company success.
If this sounds like you and you’re seeking career growth with an exciting new career path in overseeing the quality of health care for our clients and their members, please send your cover letter and resume following the instructions for this site.
Prairie States Enterprises
Equal Opportunity Employer