Transplant Case Manager IV

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-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.

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.

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
• 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

• Professional de