Manager, Case Management

Health insurance that's with you, every step of the way. • Minnetonka, MN

1d • Hybrid

About The Position

The Manager, Case Management is responsible for the daily operations and performance of Medica’s Health Services Case Management team. The role provides overall direction to clinical staff and oversees the implementation, evaluation, intervention, and improvement of programs serving Medica’s commercial and government lines of business. Case management programs focus on coordinated, process-oriented outcomes through comprehensive plans of care, collaborative interactions with members and providers, and purposeful direction of each case.

The manager oversees Case Management and Transition of Care Programs, including population-specific care coordination and complex case management, end-of-life management, post-discharge transitional care, specialty medical condition management, proactive member identification, and NCQA compliance. The position builds relationships across Medica, vendor partners, providers, and internal business and clinical teams to coordinate interventions based on members’ medical, behavioral, and social needs.

This role leads and develops case management staff, monitors productivity and program performance, supports quality and regulatory compliance, and uses reporting and analytics to identify opportunities for improved care and operational efficiency. It also serves as a subject matter expert and key clinical contact for operational issues, audits, projects, and implementation of action plans.

This is an office role requiring onsite work an average of three days per week. Candidates may be located near the Minnetonka, Minnesota, or Madison, Wisconsin, office. Medica does not offer work visa sponsorship for this role.

Requirements

• Registered Nurse (RN) pathway: Associate's or Bachelor's degree in Nursing.
• Social Work (SW) pathway: Master's degree in Social Work.
• At least 8 years of related work experience beyond the applicable degree.
• Active, unrestricted RN license in the state of residence, or active, unrestricted Independent or Advanced Practice Social Worker license in the state of residence.
• Complex project management experience.

Nice To Haves

• Certified Case Manager (CCM) certification preferred, or ability and commitment to obtain it within two years of hire.
• At least 5 years of managed care experience in health management; care management, utilization management, and disease management experience are strongly preferred.
• At least 5 years of experience leading and/or managing professional staff, including staff development and performance management.
• Experience leading case management programs.
• Experience implementing regulations, legislation, rules, laws, and accreditation standards.
• Experience with case management and utilization management tools.
• Experience with data collection, assessment tool development, analytics, and reporting.
• A proven record of successful project outcomes, including process change implementation and contributions to strategic initiatives.

Responsibilities

• Oversee and implement Case Management and Transition of Care Programs, and collaborate with case management teams to integrate programs across Medica.
• Track and evaluate productivity, program performance, and performance guarantees; develop program recommendations.
• Manage, supervise, and provide direction to case management staff, including staff development, performance management, training, and team building.
• Build and maintain relationships with Medica business segments, clinical leadership, vendor partners, providers, and internal stakeholders to coordinate member interventions and ensure seamless service.
• Serve as a case management subject matter expert and as a key clinical contact for segment operational issues and action plans.
• Maintain communication with Customer Service, Claims Operations, Provider Services, Medical Directors, Pharmacy, Account Management, and other stakeholders.
• Oversee interdisciplinary team meetings and keep leaders informed about high-cost claimants and their health management.
• Collaborate with Utilization Management, Innovation, Pharmacy, Health Care Economics, Medical Behavioral Health, vendors, and other departments to align operations and improve efficiencies.
• Develop and oversee customer and regulatory audit processes for the case management team; participate in customer, accreditation, and regulatory audits.
• Monitor case quality, decision-making, documentation, and compliance with regulatory, accreditation, and policy or procedure changes.
• Maintain efficient departmental systems and processes and ensure conformance with policies, procedures, quality improvement activities, and customer requirements.
• Collaborate on policies and procedures used by case management staff across Medica’s segments.
• Deliver departmental dashboard reporting, develop and maintain measurement tools and reports, and represent data and recommendations.
• Assess staffing and structural impacts of change, implement plans as needed, and work with the Care Support Manager to assess work distribution and staffing ratios.
• Oversee and maintain NCQA requirements and alignment, assess compliance obligations, and implement action plans to meet regulatory and accreditation standards.
• Monitor audit results and trends, assess business case recommendations, and ensure adequate staff training on regulatory and accreditation compliance.
• Track and report trends to support benefit design, medical policy decisions, and operational efficiency improvements.
• Work with departmental and cross-functional teams to implement improvement opportunities while maintaining regulatory requirements.
• Perform other duties as assigned.

Benefits

• Competitive medical, dental, and vision benefits.
• Paid time off (PTO) and holidays.
• Paid volunteer time off.
• 401(k) contributions.
• Caregiver services.
• Potential eligibility for incentive plan compensation in addition to base salary.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager