Medica is a nonprofit health plan with more than a million members that serves
communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver
personalized health care experiences and partner closely with providers to
ensure members are genuinely cared for.
We're a team that owns our work with accountability, makes data-driven
decisions, embraces continuous learning, and celebrates collaboration — because
success is a team sport. It's our mission to be there in the moments that matter
most for our members and employees. Join us in creating a community of connected
care, where coordinated, quality service is the norm and every member feels
valued.
Medica’s Case managers provide a member-centered, evidence-based model of care
across multiple products (Medicare Advantage, State Public Programs, Commercial
and Individual and Family). The Case Management program aims to serve the
members with the highest needs and help them navigate the health system.
The program is designed to telephonically serve them by understanding each
individual’s care goals, coordinate care across multiple providers and assist
with finding community resources to support their needs and goals. These
actions enable the case manager to reduce the illness burden for individuals and
their families while decreasing healthcare cost.
Responsibilities:
All members with complex illness are fully aware of their plan of care
All providers caring for our members with complex illness are fully aware of
the plan of care
All Medica care management services assisting with the case are fully aware
of the plan of care
Outcomes are comprehensive plan-of-care-driven
Additional responsibilities include:
Establishing care management accountabilities and holding those resources
accountable
Engaging the member and provider care team in care plan discussions
Member (family) engagement
Targeted program design and implementation
Qualifications:
Associate's or Bachelor's degree in Nursing
5+ years of clinical/acute care experience
Preferred Qualifications:
Utilization Management / Prior Authorization experience helpful, however not
required
Advanced experience in targeted transplant programs
Experience managing multiple computer systems and tools
Experience and at ease working with various populations: multiple age groups,
ethnic and socioeconomic backgrounds, medical, surgical backgrounds and a
generalized level of understanding across specialty care areas
Licensure/Certification:
Current, unrestricted RN license in the state of residence
Certified Case Manager (CCM) preferred, or ability to obtain within two years
of hire
Skills and Abilities:
Professional demeanor: Engaging, persistent and assertive. Empathetic,
pragmatic, prescriptive.
General working knowledge of how various health care services link together
(the health care continuum)
Excels in communication with physicians and health care providers.
Excellent internal and external customer service skills, strong decision
making skills
Ability to think creatively and be comfortable taking the lead in negotiating
and accessing resources
Ability to have positive impact on team by modeling and supporting change
Understand, articulate and support the organization’s mission, vision, goals
and strategy
Work efficiently towards department benchmarks
Excellent verbal and written skills and the ability to present in a group
setting
Ability to work positively in a fluid, ever-changing environment
Ability to thrive in fast-paced setting and make decisions under stress and
manage multiple complex issues on a daily basis
This position is a Remote role. To be eligible for consideration, candidates
must have a primary home address located within any state where Medica is
registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE,
OK, SD, TN, TX, VA, WI
The full salary grade for this position is $80,700 - $138,400. While the full
salary grade is provided, the typical hiring salary range for this role is
expected to be between $80,700 - $109,535. Annual salary range placement will
depend on a variety of factors including, but not limited to, education, work
experience, applicable certifications and/or licensure, the position's scope and
responsibility, internal pay equity and external market salary data. In
addition to compensation, Medica offers a generous total rewards package that
includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time
off, 401K contributions, caregiver services and many other benefits to support
our employees.
The compensation and benefits information is provided as of the date of this
posting. Medica’s compensation and benefits are subject to change at any time,
with or without notice, subject to applicable law.
Eligibility to work in the US: Medica does not offer work visa sponsorship for
this role. All candidates must be legally authorized to work in the United
States at the time of application. Employment is contingent on verification of
identity and eligibility to work in the United States.
We are an Equal Opportunity employer, where all qualified candidates receive
consideration for employment indiscriminate of race, religion, ethnicity,
national origin, citizenship, gender, gender identity, sexual orientation, age,
veteran status, disability, genetic information, or any other protected
characteristic.