Remote Utilization Review Rn Jobs in Shakopee, MN

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 Care Coordinators work across the state of Minnesota, and are integrated in our communities to support and care for our senior members and members living with disabilities. Our Care Coordinators are passionate about collaboratively aligning resources, creating appropriate individualized care plans, and coordinating the delivery of services for our members. Our Care Coordinators have the flexibility to choose between working a 4 or 5 day work week, as well as a consistent schedule that is free of evenings, weekends, and holidays

Medica’s Care Coordinators are home based and reside within proximity to the members they’re supporting. We support both telephonic as well as in home assessments for our members and offer the flexibility to independently schedule and manage their work based on member availability, and meeting regulatory requirements.

Care Coordination leadership and team members are focused on integrity, trust, and putting our members first. We do this by offering a supportive environment and driving the best member experience.

Key Accountabilities

• Medica Care Coordinators work independently to manage a specified case load of members and are responsible for creating an appropriate individualized care plan and coordinating the delivery of the approved medical and social services
• We provide education surrounding benefits including Medicare and Medicaid and serve as a trusted and primary contact for our members to address and mitigate any questions or concerns
• Care Coordinators partner with physicians, providers and county financial entities to discuss care plans and provide updates on member progress
• Performs other duties as assigned

We are seeking candidates who reside MN to support membership in the state.

Registered Nurse (RN) Qualifications

• RN Diploma or Degree in Nursing (Associates or Bachelors) + a minimum of 2 years’ experience in community based services, OR
• Bachelor’s degree in Nursing with a Public Health Certification + a minimum of 1 year experience in community based services
• 3-5+ years of experience beyond degree

Social Work (SW) Qualifications

• Bachelor’s degree in Social Work
• 3-5+ years of experience beyond degree, including 1-2+ years of community based services

Required Certification/ Licensure

• Active, unrestricted RN License or SW License in the state of MN Required
• MnCHOICES Certified Assessor Training (MNCAT) preferred or ability to obtain within 21 days of employment
• Public Health Certification preferred, however not required

Preferred Qualifications

• Experience in home and community based services/case management
• Experience working with those who have a disability and with seniors
• Comfortable working with diverse, low-income populations
• Strong knowledge of Medicare and Medical Assistance programs

Skills & Abilities

• Excellent interpersonal skills with the demonstrated ability to appropriately simplifying medical language into a format understandable to non-medically trained members
• Ability to shift gears quickly, function independently, be a team player, and reprioritize tasks to meet needs of members and the Medica Care System
• Strong clinical and documentation skills
• Strong innovative problem-solving ability
• Exceptional organizational skills with the ability to work independently
• Willingness to travel within Medica's Service Area
• Reliable transportation, as well as a private area of your home designated for home office environment
• General comfort level with technology, with proficiency in the Microsoft Office Suite

This position is a Remote role and will work remotely outside of traveling to member homes. You must reside in the state of MN. We offer mileage reimbursement as our Coordinators travel in the community to meet with members.

The full salary grade for this position is $62,700 - $107,500. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $62,700 - $94,080. 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.