Complex Case Manager III

Overview

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 are a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. Our mission is 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.

Medica’s RN Case Managers provide a member-centric, evidence-based model of care across multiple products. The Case Management program supports members with the highest needs, helping them navigate the complexities of the healthcare system and ensuring safe transitions between care settings. Through individualized assessments, case managers identify each member’s goals of care, coordinate services across settings, and connect members with community resources that align with their needs. This holistic approach enables case managers to reduce the burden of illness for both individuals and their families while contributing to lower overall healthcare costs. Performs other duties as assigned.

Responsibilities

Medica’s RN Case Managers provide a member-centric, evidence-based model of care across multiple products. The Case Management program is designed to support members with the highest needs, helping members navigate the complexities of the healthcare system and ensuring safe transitions between care settings. Through individualized assessments, case managers identify each member’s goals of care, coordinate services across various settings, and connect members with community resources that align with their needs. This holistic approach enables case managers to reduce the burden of illness for both individuals and their families while contributing to lower overall healthcare costs. Performs other duties as assigned.

Qualifications

• Associate or Bachelor’s degree in Nursing
• 5+ years of clinical/acute care experience

Required Certification / Licensure

• Current, unrestricted RN license in the state of residence
• Certified Case Manager (CCM) preferred, or ability and commitment to obtain within two years of hire

Preferred Qualifications

• Experience working with vulnerable and complex populations in a clinical, home care or telephonic environment; direct case management experience strongly preferred
• Experience and ease working with various populations: multiple age groups, ethnic and socioeconomic backgrounds, medical and surgical backgrounds, and a general understanding across specialty care areas
• Experience managing multiple computer systems and tools

Skills and Abilities

• Professional demeanor: Engaging, persistent and assertive. Empathetic, pragmatic, and 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 lead in negotiating and accessing resources
• Ability to positively impact the team by modeling and supporting change
• Understand, articulate and support the organization’s mission, vision, goals and strategy
• Work efficiently toward 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 a fast-paced setting, make decisions under stress, and manage multiple complex issues daily

Work Arrangement

This position is a remote role. To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer — AR, AZ, FL, GA, IA, IL, KS, KY, MD, ME, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI.

Compensation & Benefits

The full salary grade for this position is $70,700 - $121,200. While the full salary grade is provided, the typical hiring salary range is expected to be between $70,700 - $95,950. Annual salary range placement depends on factors including education, work experience, applicable certifications and/or licensure, scope of responsibility, internal pay equity, and external market data. In addition to compensation, Medica offers a generous total rewards package including medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits.

Notes on Compensation & Benefits

The compensation and benefits information is provided as of the date of this posting and may change at any time, subject to applicable law.

Equal Opportunity

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment regardless of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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