Utilization Case Manager Jobs in Minnesota (NOW HIRING)

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.

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

Additional responsibilities include:

• 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
• 7+ years of clinical/acute care experience
• 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

Preferred Qualifications:

• Utilization Management / Prior Authorization experience helpful, however not required

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 and Abilities:

• Professional demeanor: Engaging, persistent and assertive. Empathetic, pragmatic, 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, strong 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 fast-paced setting and 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, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI.

The full salary grade for this position is $80,700 - $138,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $80,700 - $109,535. 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.