Complex Case Manager III

About the role

Medica is a nonprofit health plan serving 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. This role is remote and requires a primary home address within any state where Medica is registered as an employer.

Responsibilities

• Provide a member-centric, evidence-based model of care across multiple products
• Support members with the highest needs, helping them navigate the complexities of the healthcare system and ensure safe transitions between care settings
• Identify each member’s goals of care, coordinate services across various settings, and connect members with community resources that align with their needs
• Reduce the burden of illness for both individuals and their families while contributing to lower overall healthcare costs

Required Qualifications

• Associate's or Bachelor's degree in Nursing
• 5+ years of clinical/acute care experience beyond degree
• Certified Case Manager (CCM) preferred, or ability and commitment to obtain within two years of hire
• Experience working with vulnerable and complex populations in a clinical, home care or telephonic environment
• 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
• Experience managing multiple computer systems and tools
• Professional demeanor: Engaging, persistent and assertive
• Empathetic, pragmatic, and prescriptive
• General working knowledge of how various health care services link together (the health care continuum)
• Sound clinical foundation and familiarity with chronic conditions, ADLs/IADLs, and social determinants of health
• Excellent internal and external customer service skills
• Strong analytical 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 a fast-paced setting, make decisions under stress, and manage multiple complex issues daily

Preferred Qualifications

• Experience working with vulnerable and complex populations in a clinical, home care or telephonic environment
• Direct case management experience strongly preferred
• 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
• Experience managing multiple computer systems and tools
• Professional demeanor: Engaging, persistent and assertive
• Empathetic, pragmatic, and prescriptive
• General working knowledge of how various health care services link together (the health care continuum)
• Sound clinical foundation and familiarity with chronic conditions, ADLs/IADLs, and social determinants of health
• Excellent internal and external customer service skills
• Strong analytical 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 a fast-paced setting, make decisions under stress, and manage multiple complex issues daily

Benefits

The full salary grade for this position is $72,100 - $123,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $72,100 - $97,850. 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.

Pay

The full salary grade for this position is $72,100 - $123,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $72,100 - $97,850. 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.

Schedule

This position is a Remote role.