Case Manager III

Medica•,

2d•$72,100 - $123,600•Remote

About The Position

Medica is a nonprofit health plan serving over a million members across multiple states, focusing on personalized healthcare experiences and provider partnerships. The Case Management program aims to support members with the highest needs in navigating the healthcare system through telephonic outreach, understanding individual goals of care, coordinating care, and assisting with accessing necessary services. This specific Case Management opportunity will focus on Medica's North Dakota Medicare Advantage Dual Special Needs Plans (DSNP) membership. The role involves providing education, managing medical case management interventions, collaborating with the member's care team, and addressing social determinants of health by identifying resources and partnering with relevant agencies. The ultimate goal is to reduce illness burden for individuals and families, thereby decreasing healthcare costs. Key deliverables include ensuring all North Dakota DSNP members are supported by a case manager, conducting annual Health Risk Assessments (HRAs) as required by CMS, collaborating on care plans based on HRA findings, driving outcomes through a comprehensive care plan, and supporting care transitions within required timelines. Other duties may be assigned.

Requirements

Associate's or Bachelor's degree in Nursing
5+ years of experience in an acute care, home care, or community-based care setting
Experience utilizing an EHR/clinical documentation platform
Experience working with various populations: multiple age groups, vulnerable and complex populations, and diverse ethnic and socioeconomic backgrounds, including seniors and those with disabilities
Current, unrestricted RN license in the state of residence
Ability to obtain Certified Case Manager (CCM) within two years of hire
Eligibility to work in the US
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

Nice To Haves

Certified Case Manager (CCM)
Strong knowledge of Medicare and Medicaid programs, specifically North Dakota Medicaid
Experience with, and knowledge of, community-based organizations and resources in North Dakota
Experience with health plans and case management
Medical/surgical background and a generalized level of understanding across specialty care areas

Responsibilities

All members enrolled in the North Dakota DSNP product are supported by a case manager
Engaging the member/caregiver in an annual Health Risk Assessment (HRA) as required by CMS
Care plan collaboration and development based on individual needs identified in the HRA, including the member, family/caregiver and provider care team
Outcomes are driven via the comprehensive plan of care
Care transitions are supported based on required timelines
Perform other duties as assigned