Case Manager III

About the role

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‑centric, evidence‑based model of care across multiple programs and products. The Case Management program aims to serve our members with the highest needs to navigate the healthcare system. The program is designed to telephonically serve members by understanding each individual’s goals of care, coordinating care across the healthcare continuum, and providing assistance with accessing care and services to support a member’s individualized needs. This Case Management opportunity will serve our North Dakota Medicare Advantage Dual Special Needs Plans (DSNP) membership. The focus will be on providing education, managing medical case management interventions, collaborating with the member’s established care team, and supporting social determinants of health through resource identification and collaboration with appropriate agencies. These actions enable the case manager to reduce the illness burden for individuals and their families, thereby decreasing healthcare costs.

Responsibilities

• Perform other duties as assigned.
• Ensure all members enrolled in the North Dakota DSNP product are supported by a case manager.
• Engage the member/caregiver in an annual Health Risk Assessment (HRA) as required by CMS.
• Collaborate on care plan development based on individual needs identified in the HRA, including the member, family/caregiver and provider care team.
• Drive outcomes via the comprehensive plan of care.
• Support care transitions based on required timelines.

Requirements

• Associate's or Bachelor's degree in Nursing.
• 5+ years of experience in an acute care, home care, or community‑based care setting.
• Experience utilizing an EHR/clinical documentation platform.
• Experience working with various populations: multiple age groups, vulnerable and complex populations, and diverse ethnic and socioeconomic backgrounds, including seniors and those with disabilities.
• Current, unrestricted RN license in the state of residence.
• Certified Case Manager (CCM) preferred, or ability to obtain within two years of hire.

Qualifications

• Strong knowledge of Medicare and Medicaid programs, specifically North Dakota Medicaid.
• Experience with, and knowledge of, community‑based organizations and resources in North Dakota.
• Experience with health plans and case management.
• Medical/surgical background and a generalized level of understanding across specialty care areas.

Skills and Abilities

• Professional demeanor: engaging, persistent and assertive; empathetic, pragmatic, prescriptive.
• Excellent interpersonal skills with the demonstrated ability to appropriately simplify medical language into a format understandable to individuals with limited medical background.
• Strong clinical and documentation skills.
• General working knowledge of the healthcare continuum and how various health care services link together including hospital, skilled nursing facilities and community‑based services.
• Excel in communication with physicians and health care providers.
• Ability to use motivational interviewing and active listening skills in member interactions.
• Ability to think creatively and be comfortable taking the lead in negotiating and accessing resources.
• Ability to have a 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 communication skills and the ability to present in a group setting.
• Ability to work positively in a fluid, ever‑changing environment