Complex Case Manager III

Medica•,

6h•$72,100 - $97,850•Remote

About The Position

Medica is a nonprofit health plan serving over a million members across multiple states. We focus on delivering personalized healthcare experiences and collaborating with providers to ensure members receive quality care. Our team values accountability, data-driven decisions, continuous learning, and collaboration. The RN Case Managers at Medica utilize a member-centric, evidence-based model of care across various products, focusing on members with the highest needs to help them navigate the healthcare system. This role involves working with members, families, caregivers, providers, and interdisciplinary teams to provide holistic care. Responsibilities include conducting comprehensive assessments, developing and monitoring individualized care plans, and coordinating services across the healthcare continuum to reduce illness burden and healthcare costs.

Requirements

Associate's degree in Nursing or equivalent work experience in a related field.
5 years of work experience beyond degree in clinical/acute care nursing.
Current, unrestricted RN license in the state of residence.
RN degree required.
Eligibility to work in the US; Medica does not offer work visa sponsorship.
Legally authorized to work in the United States at the time of application.

Nice To Haves

Certified Case Manager (CCM) preferred, or ability and commitment to obtain within two years of hire.
Experience working with vulnerable and complex populations, including multiple age groups, ethnic and socioeconomic backgrounds in a clinical, home care or telephonic environment.
Direct case management experience strongly preferred.
Knowledge of managed care principles and regulatory guidelines preferred.
Proficiency in electronic health records and care management software.

Responsibilities

Conduct comprehensive assessments.
Develop, implement, and monitor individualized care plans.
Coordinate services across the healthcare continuum.
Collaborate with members, families, caregivers, providers, and interdisciplinary teams.
Perform other duties assigned.