TOC Case Manager III

Medica; United States; Remote; USD 70,000 - 96,000; Full time

Job summary

A leading health plan provider is seeking an RN Case Manager to deliver member-centered care. This remote role involves assessing care goals, coordinating services, and connecting members with resources. Candidates must have an Associate’s or Bachelor’s in Nursing, along with 5+ years of clinical experience. The position offers a competitive salary range of $70,700 - $95,950 and includes a comprehensive benefits package.

Benefits

Competitive medical, dental, vision benefits

Paid volunteer time off

401K contributions

Qualifications

• 5+ years of clinical/acute care experience.
• Current, unrestricted RN license in the state of residence.
• Certified Case Manager (CCM) preferred, or ability to obtain.

Responsibilities

• Assess individual care goals for members.
• Coordinate medical and supportive services.
• Connect members with community resources.

Skills

Professional demeanor

Communication skills

Decision-making skills

Customer service

Ability to thrive under stress

Education

Associate’s or Bachelor’s degree in Nursing

Tools

Microsoft Products

Job description

Overview

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 RN Case Managers provide a member-centered, evidence-based model of care across multiple products. Our Case Management program is responsible for ensuring a smooth and safe transition for members between various care settings. This role involves assessing individual care goals, coordinating medical and supportive services, and connecting members with community resources to support their needs and objectives.

These actions enable the case manager to reduce the illness burden for individuals and their families while decreasing healthcare costs.

Responsibilities

Note: The original description emphasizes assessment, coordination, and connecting members with resources to support goals and transitions between care settings.

Qualifications

Required Qualifications

• Associate’s or Bachelor’s degree in Nursing
• 5+ years of clinical/acute care experience

Required Certifications/Licensure

• 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 required

Preferred Qualifications

• Experience working with vulnerable and complex populations in a clinical, home care or telephonic environment; direct case management experience strongly preferred
• Experience and at ease working with various populations: multiple age groups, ethnic and socioeconomic backgrounds, medical, surgical backgrounds and a generalized level of understanding across specialty care areas
• Experience managing multiple computer systems and tools including Microsoft Products and medical documentation platforms

Skills and Abilities

• 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)
• Excels in communication with physicians and health care providers
• Excellent internal and external customer service skills
• Strong decision-making 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

Location and Eligibility

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, MD, ME, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI.

Compensation and Benefits

Full salary grade for this position is $70,700 - $121,200. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,700 - $95,950. 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

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.