Advanced Illness Complex Case Manager III

Medica's RN Case Managers provide a member-centric, evidence-based model of care across multiple products. Our Case Management program aims to serve the members with highest needs and help them navigate the health system. The Advanced Illness program focuses on optimizing patient outcomes, improving quality of life, and ensuring efficient utilization of healthcare resources while aligning with a member's established plan of care. This position involves collaboration with members and their families, caregivers, providers, and interdisciplinary teams to deliver holistic care.

The case manager will be responsible for conducting comprehensive assessments, developing, implementing, and monitoring individualized care plans, facilitating advanced care planning discussions, and coordinating services across the healthcare continuum. These actions enable the case manager to reduce the illness burden for individuals and their families while decreasing healthcare costs.

Minimum Qualifications

• Associate or Bachelor degree in Nursing
• 5+ years of clinical/acute care nursing experience with a focus on advanced illness, hospice, palliative care, or chronic disease management
• Experience working with vulnerable and complex populations, including multiple age groups, ethnic and socioeconomic backgrounds provided in a clinical, home care or telephonic environment; direct case management experience strongly preferred
• Knowledge of managed care principles and regulatory guidelines preferred
• Proficiency in electronic health records and care management software

Licensure/Certification

• 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

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 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 a fast-paced setting, make decisions under stress, and manage multiple complex issues on a daily basis

This position is a Remote role and will work remotely 100% of the time. 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.

The full salary range for this position is $70,700 - $121,200. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, 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.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

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