Supervisor, Care Coordination

Medica; Hopkins (MN); On-site; USD 90,000 - 120,000; Full time

Job summary

Medica is a nonprofit health plan delivering care to members in Minnesota and beyond. This role leads a team of care coordinators for State Public Programs (MSHO, MSC+ and SNBC), overseeing daily operations to ensure high-quality, coordinated care and regulatory compliance.

The manager will mentor staff, utilize data-driven tools, and collaborate across Medica teams to optimize member outcomes. You will supervise the panel of members, guide performance, and implement training and development for

Qualifications

• RN Diploma or Degree in Nursing (Associates or Bachelors).
• Minimum of 2 years’ experience in community-based care.

Responsibilities

• Supervise care coordinators and mentor team members.
• Educate the team on using membership data and tools to coordinate care.
• Manage the care coordination for assigned member panels and ensure regulatory compliance.
• Oversee daily operations and clinical care for assigned members, including performance monitoring.
• Coordinate with other Medica teams (sales, operations, regulatory) to ensure continuity of care.
• Participate in on-call duties as needed.

Education

RN Diploma or 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.

This position is responsible for managing a team of care coordinator for the provision of care coordination services for State Public Programs and other Medica members. The majority of members will be from our Care Coordination Products (MSHO, MSC+ and SNBC) within State Public Programs and the Government division. This position provides direct supervision to the Care Coordinators.

This position has direct oversight and responsibility for the assigned panel of members, a subset of a larger panel of members of the geographic regions of the products’ service areas and/or a definable segments/subset of the membership, and takes responsibility for those members.

This position is responsible for daily operations and the clinical care provided to those assigned members. This includes:

• Supervision of the care coordinators including responsibilities to mentor coordinators, provide consistent communication to assigned care team, train and encourage team building with direct and indirect reports.
• Education of the team on how to use membership information (reports, algorithms and other tools which prioritize, integrate and coordinate interventions based on medical, behavioral and social needs) for assigned members to facilitate members health maintenance, improvement and/or self-care management.
• Population specific care coordination for the vulnerable populations including low income, vulnerable adults, seniors, disabled and/or medical assistance populations.
• Management of the vulnerable populations’ clinical care coordination in accordance with prescribed guideline, regulations, policies and procedures to ensure appropriate utilization of health care services and resources.
• Performance of the team, through monitoring and audits, on the team’s ability to implementation of the care coordination models of care for vulnerable populations to ensure member satisfaction and regulatory compliance.

This position is responsible to assist the Manager, Care Coordination in the implementation and evaluation of Medica Care System care coordination services. This position will implement improvement and/or corrective action plan as needed. Performs other duties as assigned.

Key Accountabilities

• Provide direct supervision to the team assigned to the panel of members
  • Communicate accurate and timely information to team members to enhance their effectiveness and the efficiency. Foster positive team dynamics and encourages team members to support one another. Conduct routine team meetings.
  • Monitor the care coordinators performance throughout the year including the progress towards goals, clinical performance and clinical documentation. Recognize and reward good work.
  • Conduct joint member visits with care coordinators, chart reviews and completion of audit tools. Review charts in preparation for external and internal audits.
  • Adjust the Care Coordinator workload, caseload totals and monthly visits/contacts on a routine bases, following consultation with Clinical Care Manager.
  • Provide thoughtful, fair and accurate evaluation of each team member. Deliver feedback throughout the year and annually in accordance with human resources policies, procedures and tools
  • Implement training and development opportunities for the Care Coordinators.
  • Monitor care coordinators training, licenses and certifications including MnCHOICES.
  • Be willing to manage a caseload of member base on caseload size and member needs of the panel of members.

• Educate team and acts as a resource for issues that arise
  • Act as a resource for the team. Share community knowledge of health and supportive services with clinical team. Research and respond to question posed by team.
  • Train, mentor and develop Care Coordinators. Mentor newly hired Care Coordinators and supervise all aspects of their training.
  • Establish orientation and training process and update process and tools based on feedback, experience and/or recommendations.
  • Instruct care coordinators on how to keep themselves safe when in the community and provide guidelines.

• Manage the provision of care coordination of the assigned members
  • Assign members to the most appropriate care coordinator to meet member’s needs and administrative budget.
  • Improve the effectives and efficiency of the team’s performance
  • Instruct team on prescribed policies and procedures as well as best practices to ensure compliance with regulatory and contractual requirements.
  • Instruct team on the model of care for the vulnerable populations and how to coordinate the medical, social service, mental health and chemical health of the members.
  • Offer suggestions for improvement and participation in revision/modification to current processes and/or creation of new.
  • Instruct care coordinators on how to leverage interdisciplinary team, (including Nurse Practitioners (NP) from SPP’s Integrated Care by Medica Clinical team, internal medical director from Health Management, pharmacist and others) for member consultation to meet member’s medical and social needs.
  • Ensure care coordinators develops appropriate care plan for members and communicates progress with physicians, members, family and providers.
  • Conduct interdisciplinary care team reviews and care coordinator home office audits.
  • Work with Medica Care System sales, operations and regulatory teams to share information, identify needs and promote continuity of care for members.
  • Work to foster relationships within team and within Medica, willing represent Medica for outreach to member or potential member groups and participates in SPP and organization-wide projects as requested.
  • Display exemplary care coordination skills, when needed, as it relates to clinical knowledge, working with members, completing all required documentation and timeliness of all member related work.
  • Participate in on-call program as needed.

• Monitor performance of team providing care coordination to the panel of members
  • Monitor team metrics to ensure timely completion of member assessment (Initial, annual and others) and data entry into state’s MMIS tracking system. Track and evaluate timeliness of members’ assessments by care coordinators. Identify any assessments at risk for timely completion and take action with care coordinators as needed.
  • Follow through on instructions from Clinical Care Manager to increase care coordinators contact with member based on membership stratification into care levels, the MCS Enhanced Care Coordination (ECC) Model.
  • Complete the care coordination assignment process, upon receipt of the routine enrollment lists, to ensure operational and administrative efficiencies.
  • Conduct audits as instructed to demonstrate compliance with regulatory and contractual requirements. Implement corrective action plans as needed.
  • Monitor the members’ Elderly Waiver (EW) budget against guidelines and instructs care coordinators about each member’s utilization of services.
  • Monitor the members’ Medicaid Eligibility and instructs care coordinator about each member’s renewal.
  • Utilize additional data collection tools, systems and reports to support operational performance and improvement. Create and implement corrective action plans as needed.

Required Qualifications

• RN Diploma or Degree in Nursing (Associates or Bachelors) + a minimum of 2 years’ experience in community based