Case Manager III

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. Perform other duties as assigned.This role's deliverables are related to process-orientated outcomes:All members enrolled in the North Dakota DSNP product are supported by a case managerEngaging the member/caregiver in an annual Health Risk Assessment (HRA) as required by CMSCare plan collaboration and development based on individual needs identified in the HRA, including the member, family/caregiver and provider care teamOutcomes are driven via the comprehensive plan of careCare transitions are supported based on required timelinesRequired QualificationsAssociate's or Bachelor's degree in Nursing5+ years of experience in an acute care, home care, or community-based care settingExperience utilizing an EHR/clinical documentation platformExperience working with various populations: multiple age groups, vulnerable and complex populations, and diverse ethnic and socioeconomic backgrounds, including seniors and those with disabilitiesRequired Certifications/ LicensureCurrent, unrestricted RN license in the state of residenceCertified Case Manager (CCM) preferred, or ability to obtain within two years of hirePreferred QualificationsStrong knowledge of Medicare and Medicaid programs, specifically North Dakota MedicaidExperience with, and knowledge of, community-based organizations and resources in North DakotaExperience with health plans and case managementMedical/surgical background and a generalized level of understanding across specialty care areasSkills and AbilitiesProfessional demeanor: Engaging, persistent and assertive. Empathetic, pragmatic, prescriptiveExcellent interpersonal skills with the demonstrated ability to appropriately simplify medical language into a format understandable to individuals with limited medical background and knowledgeStrong clinical and documentation skillsGeneral working knowledge of the healthcare continuum and how various health care services link together including hospital, skilled nursing facilities and community-based servicesExcel in communication with physicians and health care providersAbility to use motivational interviewing and active listening skills in member interactionsAbility to think creatively and be comfortable taking the lead in negotiating and accessing resourcesAbility to have a positive impact on team by modeling and supporting changeUnderstand, articulate and support the organization's mission, vision, goals and strategyWork efficiently towards department benchmarksExcellent verbal and written communication skills and the ability to present in a group settingAbility to work positively in a fluid, ever-changing environmentAbility to thrive in a fast-paced setting, make decisions under stress, and manage complex issues on a daily basisThis 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, WIThe 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.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.Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.J-18808-Ljbffr