Manager, Case Management

Medica; Minnetonka (MN, AL); On-site; USD 85,000 - 110,000; Full time

Job summary

Medica, a nonprofit health plan serving communities in Minnesota and beyond, seeks a Manager, Case Management to lead the Health Services Case Management team. You will oversee daily operations and drive performance, coordinating interventions across vendor partners and provider care teams to ensure members receive coordinated, high-quality care.

You will champion NCQA compliance, use predictive modeling to identify high-need members, and guide complex case management, transitional care, and

Qualifications

• Experience in health plan case management.
• Ability to build partnerships with providers and vendors.
• Knowledge of NCQA requirements and quality initiatives.
• Data-driven decision making in care coordination.

Responsibilities

• Relationship building within Medica and its vendor partners to prioritize, integrate and coordinate interventions for population segments based on medical, behavioral and social needs.
• Relationship building with provider care teams as accountable partners facilitating member self-care management.
• Adoption of transformational interventions and case management models for conditions and populations driving medical expense trend.
• Population specific complex case management.
• EOL management.
• Transitional care management (post-discharge).
• NCQA compliance.
• Predictive modeling and proactive member identification.

Skills

Relationship building

Population health

Case management

Data analytics

Job description

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're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission 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.

The Manager, Case Management is responsible for daily operations and the performance of the Health Services Case Management team. This includes:

• Relationship building within Medica and its vendor partners to prioritize, integrate and coordinate interventions for population segments based on medical, behavioral and social needs
• Relationship building with provider care teams as accountable partners facilitating member self-care management
• Adoption of transformational interventions and case management models for conditions and populations driving medical expense trend
• Population specific complex case management
• EOL management
• Transitional care management (post-discharge)
• NCQA compliance
• Predictive modeling and proactive member identification