Pregnancy Case Manager III

Ultipro; Missouri; Hybrid; USD 72,000 - 124,000; Full time

Job summary

Medica is a nonprofit health plan serving communities across several states. The Pregnancy RN Case Manager supports maternal health through education, care coordination, and advocacy, with a focus on high-need members and healthy birth outcomes.

The role emphasizes assessments, care planning, and cross-functional coordination to improve outcomes while managing costs. A nursing degree and active RN license are required, with CCM preferred and obtainable within two years.

Qualifications

• Must have nursing degree and active RN license.
• Minimum 3+ years of clinical/acute care experience including direct maternal patient care.

Responsibilities

• Conduct comprehensive assessments and develop individualized care plans.
• Implement and monitor care plans across the healthcare continuum.
• Coordinate services across multiple providers to reduce pregnancy/birth complications and costs.

Skills

Pregnancy population experience

Excellent verbal and written skills

Multisystem/Computer proficiency

Professional demeanor and empathy

Creative problem solving

Education

Associate or bachelor’s degree in nursing

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.

Medica’s Pregnancy RN Case Managers provide a member-centered, evidence-based model of care across multiple products. Our Pregnancy Case Management program aims to serve maternal members with the highest needs and help them navigate the health system with the aim of healthy birth outcomes. The Pregnancy Program focuses on improving maternal and infant health outcomes by delivering education, care coordination, identifying gaps in care, and advocacy.

The case manager will be responsible for conducting comprehensive assessments, developing, implementing, and monitoring individualized care plans, and coordinating services across the healthcare continuum. These actions enable the case manager to reduce the risk of pregnancy and birth related complications for individuals and their families while decreasing healthcare costs.

Minimum Qualifications

• Associate or bachelor’s degree in nursing
• 3+ years of clinical/acute care experience including direct maternal patient care

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

• Experience working with the pregnancy population in a clinical or home care setting; direct case management experience strongly preferred.
• Experience and at ease working with various populations: multiple age groups, ethnic and socioeconomic backgrounds, and a generalized level of understanding across specialty care areas.
• Experience managing multiple computer systems and tools.
• 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).
• Sound clinical foundation in maternal health, with expertise in pregnancy care, management of common complications (e.g., preeclampsia, gestational diabetes, preterm labor), and support for postpartum recovery, including physical and mental health considerations.
• NICU and pediatric experience preferred but not required.
• Excels in communication with physicians and health care providers.
• Excellent internal and external customer service 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.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, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI

The full salary grade for this position is $72,100 - $123,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $72,100 - $97,850. 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.

Eligibility to work in the US:Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

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.

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.