Hybrid Manager, Case Management & Care Coordination

Medica Services Company LLC; Minnetonka (MN); Hybrid; USD 89,000 - 133,000; Full time

Job summary

Medica, a nonprofit health plan in Minnesota, seeks a Manager, Case Management in Minnetonka, MN. Lead the Health Services Case Management team, overseeing Case Management and Transition of Care programs and coordinating interventions for diverse population segments.

You will drive NCQA compliance, monitor program performance, and collaborate across departments while mentoring staff. This onsite role requires average 3 days on-site and offers a comprehensive rewards package.

Qualifications

• RN license and nursing degree required
• Master's degree in Social Work required
• Experience in managed care and case management
• Experience with data-related analytics and reporting

Responsibilities

• Oversight and implementation of Case Management and Transition of Care Programs.
• Collaborates with Medica Case Management teams to assure integration across all Case Management Programs at Medica.
• Tracks productivity, program performance and the performance guarantees; develops program recommendations.
• Collaborates with business segments and clinical leadership to ensure seamless operations and service.
• Provides management, supervision, and direction to case management staff.
• Acts as a subject matter expert for case management for Medica, clients and project teams.
• Maintains communication between stakeholders and departments (Customer Service, Claims Operations, Provider Services, Medical Directors, Pharmacy, Account Management).
• Oversees Interdisciplinary Team meetings and informs leaders of high-cost claimants and health management.
• Develops and oversees processes for audits and regulatory/compliance requirements.

Skills

Case management

Data collection

Assessment tools

Analytics & reporting

Education

Associate's or Bachelor's degree in Nursing

Master's degree in Social Work

Tools

Case management tools

Utilization management tools

Job description

Medica, a nonprofit health plan in Minnesota, seeks a Manager, Case Management in Minnetonka, MN. Lead the Health Services Case Management team, overseeing Case Management and Transition of Care programs and coordinating interventions for diverse population segments.

You will drive NCQA compliance, monitor program performance, and collaborate across departments while mentoring staff. This onsite role requires average 3 days on-site and offers a comprehensive rewards package.