Case Management & Transitions Lead

Medica; Hopkins (MN); On-site; USD 89,000 - 133,000; Full time

Job summary

Medica is seeking a Manager, Case Management to lead the Health Services Case Management team and drive population-specific care coordination, transitional care, and NCQA compliance. The role emphasizes data-driven improvements to reduce medical expense trends and ensure quality service for members and providers.

The position requires an RN or MSW with 8+ years in managed care; CCM preferred. Office-based with onsite work three days per week in Minnetonka, MN or Madison, WI; generous rewards

Qualifications

• Active RN license in the state of residence or equivalent licensure.
• Master's degree in Social Work preferred with 8+ years of related work experience.
• CCM certification preferred or to be obtained within two years.

Responsibilities

• Oversee Case Management and Transition of Care programs and integrations.
• Provide leadership to case management staff and ensure NCQA alignment.
• Collaborate with provider teams, vendor partners, and health segments.
• Ensure regulatory compliance, audits, and performance reporting.
• Monitor trends to inform benefit design and care decisions.

Skills

RN License

CCM preferred

Managed care experience

Education

Associate's or Bachelor's degree in Nursing

Master's degree in Social Work

Job description

Medica is seeking a Manager, Case Management to lead the Health Services Case Management team and drive population-specific care coordination, transitional care, and NCQA compliance. The role emphasizes data-driven improvements to reduce medical expense trends and ensure quality service for members and providers.

The position requires an RN or MSW with 8+ years in managed care; CCM preferred. Office-based with onsite work three days per week in Minnetonka, MN or Madison, WI; generous rewards