TOC Case Manager III

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Remote

• Remote
• Health Services
• Full-Time
• Requisition #: CASEM
  006337

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 RN Case Managers provide a member-centered, evidence-based model of care across multiple products. Our Case Management program is responsible for ensuring a smooth and safe transition for members between various care settings. This role involves assessing individual care goals, coordinating medical and supportive services, and connecting members with community resources to support their needs and objectives.

The case manager will be responsible for ensuring a safe transition by conducting discharge assessments, medication reconciliation, reviewing warning signs and symptoms and ensuring follow up appointments are scheduled and attended. These actions enable the case manager to reduce the illness burden for individuals and their families while decreasing healthcare costs.

• Associate’s or Bachelor’s degree in Nursing
• 3+ years of clinical/acute care experience

• Current, unrestricted RN license in the state of residence
• Certified Case Manager (CCM) preferred, or ability and commitment to obtain within two years of hire required

• 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 including Microsoft Products and medical documentation platforms.
• 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).
• Excels in communication with physicians and health care providers.
• Excellent internal and external customer service 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 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,…