TOC Case Manager III

Medica•,

4d•$72,100 - $97,850•Remote

About The Position

Medica’s RN Case Managers provide a member-centered, evidence-based model of care across multiple products. The Case Management program ensures smooth and safe transitions for members between care settings. This role assesses individual care goals, coordinates medical and supportive services, and connects members with community resources to support members’ needs and objectives. The case manager supports safe transitions by conducting discharge assessments, reconciling medications, reviewing warning signs and symptoms, and ensuring follow-up appointments are scheduled and attended. These activities help reduce illness burden for members and their families while decreasing healthcare costs. This is a remote position. Candidates must have a primary home address in a 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, or WI. Medica does not offer work visa sponsorship; applicants must be legally authorized to work in the United States at the time of application.

Requirements

Associate’s or bachelor’s degree in Nursing.
At least 3 years of clinical or acute care experience.
Current, unrestricted RN license in the state of residence.
Certified Case Manager (CCM) certification is preferred; otherwise, ability and commitment to obtain it within two years of hire is required.

Nice To Haves

Experience working with vulnerable and complex populations in clinical, home care, or telephonic environments; direct case management experience is strongly preferred.
Experience working with multiple age groups, ethnic and socioeconomic backgrounds, medical and surgical backgrounds, and a generalized understanding across specialty care areas.
Experience managing multiple computer systems and tools, including Microsoft products and medical documentation platforms.
Professional demeanor that is engaging, persistent, assertive, empathetic, pragmatic, and prescriptive.
General working knowledge of how health care services link across the health care continuum.
Ability to communicate effectively with physicians and health care providers.
Excellent internal and external customer service skills.
Strong decision-making skills.
Ability to think creatively and take the lead in negotiating and accessing resources.
Ability to positively impact the team by modeling and supporting change.
Ability to understand, articulate, and support the organization’s mission, vision, goals, and strategy.
Excellent verbal and written communication skills and ability to present in a group setting.
Ability to work positively in a fluid, changing environment and thrive in a fast-paced setting, make decisions under stress, and manage multiple complex issues daily.

Responsibilities

Assess individual member care goals.
Coordinate medical and supportive services and connect members with community resources.
Conduct discharge assessments to support safe transitions between care settings.
Complete medication reconciliation.
Review warning signs and symptoms with members.
Ensure follow-up appointments are scheduled and attended.
Work efficiently toward department benchmarks and manage complex issues.