Transplant Case Manager

Medica•,

6d•$80,700 - $138,400•Remote

About The Position

Medica is a nonprofit health plan serving over a million members across multiple states. They focus on delivering personalized healthcare experiences and collaborating with providers. The Case Management program aims to support members with the highest needs by helping them navigate the health system. Case managers use a member-centered, evidence-based model of care telephonically, understanding individual care goals, coordinating care across providers, and assisting with community resources to reduce illness burden and healthcare costs.

Requirements

Associate's or Bachelor's degree in Nursing
7+ years of clinical/acute care experience
Advanced experience in targeted transplant programs
Experience managing multiple computer systems and tools
Experience and at ease working with various populations: multiple age groups, ethnic and socioeconomic backgrounds, medical, surgical backgrounds and a generalized level of understanding across specialty care areas
Current, unrestricted RN license in the state of residence
Professional demeanor: Engaging, persistent and assertive. Empathetic, pragmatic, prescriptive.
General working knowledge of how various health care services link together (the health care continuum)
Excels in communication with physicians and health care providers.
Excellent internal and external customer service skills, strong decision making skills
Ability to think creatively and be comfortable taking the lead in negotiating and accessing resources
Ability to have positive impact on team by modeling and supporting change
Understand, articulate and support the organization’s mission, vision, goals and strategy
Work efficiently towards department benchmarks
Excellent verbal and written skills and the ability to present in a group setting
Ability to work positively in a fluid, ever-changing environment
Ability to thrive in fast-paced setting and make decisions under stress and manage multiple complex issues on a daily basis
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

Nice To Haves

Certified Case Manager (CCM) preferred, or ability to obtain within two years of hire
Utilization Management / Prior Authorization experience helpful, however not required

Responsibilities

All members with complex illness are fully aware of their plan of care
All providers caring for our members with complex illness are fully aware of the plan of care
All Medica care management services assisting with the case are fully aware of the plan of care
Outcomes are comprehensive plan-of-care-driven
Establishing care management accountabilities and holding those resources accountable
Engaging the member and provider care team in care plan discussions
Member (family) engagement
Targeted program design and implementation