Manager, Clinical Care Support Specialist Teams

Medica • Minnetonka, MN

6d • Hybrid

About The Position

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. The Manager, Care Coordination (RN) is responsible for the day-to-day management and oversight of the Medica Care System supervisors and care coordinators, with primary responsibility for the Nursing teams within the Medica Care System. The majority of members this team works with will be from our Care Coordination Products (MSHO, MSC+ and SNBC) and Medicare Advantage. The incumbent is responsible for implementation and evaluation/revision of care coordination provided by the Medica Care System. The incumbent assures that the Medica Care System is in compliance with the Medica model of care coordination and adheres to required timelines associated to care coordination tasks. Performs other duties as assigned.

Requirements

• RN Diploma or Degree in Nursing (Associates or Bachelors) + a minimum of 2 years’ experience in community based services, OR Bachelor's degree in Social Work + a minimum of 1-2+ years of community based services
• 5+ years clinical experience
• 5+ years supervisory experience of professional staff, including employees who are home office or located remotely; informal leadership that has included coaching and mentorship will also be considered
• Active, unrestricted RN OR SW License in the state of MN
• Required MnCHOICES Certified Assessor Training (MNCAT) preferred or ability to obtain within 21 days of employment
• Experience implementing changes to modeling approaches for seniors or people with disabilities
• Demonstrated quality initiative and outcome experience
• Experience in a managed care environment with background knowledge of Medicaid/ and/or Medicare regulations and standards
• Past experience with Medicare, Medicaid, Waiver Management, MSHO, MSC+, SNBC and Medicare Advantage

Nice To Haves

• Public Health Certification preferred, however not required

Responsibilities

• Management of Medica Care System team
• Tracks and evaluates productivity, and overall team performance
• Oversight of care coordination trainings and education to include education from internal departments
• Allocation of FTE’s to manage all internal MCS membership efficiently and effectively
• Creates positive team climate by setting individual and team goals and achieving results, eliminating non-value added activities, and recognizing and rewarding good work
• Provides clinical support and consultation on medically complex cases, utilizing Medica guidelines and tools
• Uses nursing processes and knowledge to assist staff in managing cases
• Management of care coordination model
• Suggests changes to programs to achieve “best in class.” Anticipates changes needed to processes to best serve members and create efficiencies where needed
• Oversight of Medica Care System model with focus on member outcomes which drive revenue and reduce medical trends appropriately
• Monitors team quality to ensure team competence in decision-making, documentation and compliance with regulatory, accreditation and policy/procedure change
• Provides oversight for policies and procedures for Medica Care System care coordinators
• Interfacing with stakeholders
• Collaborates closely and maintains communication between internal and external stakeholders and departments
• Collaborates with Health Services team, Care Coordination Manager –SW, Manager, Medica Care System, and others on the effective delivery of care coordination services
• Collaborator with others related to Medicare Advantage and the clinical support being provided for this product

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree