Medicare Advantage Case Manager III

Medica's case managers provide a member-centric, evidence-based model of care across multiple programs and products. The Case Management program aims to serve our members with the highest needs to navigate the healthcare system. The program is designed to telephonically serve members by understanding each individual's goals of care, coordinating care across the healthcare continuum, and providing assistance with accessing care and services to support a member's individualized needs.

This Case Management opportunity will serve our North Dakota Medicare Advantage Dual Special Needs Plans (DSNP) membership. The focus will be on providing education, managing medical case management interventions, collaborating with the member's established care team, and supporting social determinants of health through resource identification and collaboration with appropriate agencies. These actions enable the case manager to reduce the illness burden for individuals and their families, thereby decreasing healthcare costs. Perform other duties as assigned.

This role's deliverables are related to process-orientated outcomes:

• All members enrolled in the North Dakota DSNP product are supported by a case manager
• Engaging the member/caregiver in an annual Health Risk Assessment (HRA) as required by CMS
• Care plan collaboration and development based on individual needs identified in the HRA, including the member, family/caregiver and provider care team
• Outcomes are driven via the comprehensive plan of care
• Care transitions are supported based on required timelines

Required Qualifications:

• Associate's or Bachelor's degree in Nursing
• 5+ years of experience in an acute care, home care, or community-based care setting
• Experience utilizing an EHR/clinical documentation platform
• Experience working with various populations: multiple age groups, vulnerable and complex populations, and diverse ethnic and socioeconomic backgrounds, including seniors and those with disabilities

Required Certifications/ Licensure:

• Current, unrestricted RN license in the state of residence
• Certified Case Manager (CCM) preferred, or ability to obtain within two years of hire

Preferred Qualifications:

• Strong knowledge of Medicare and Medicaid programs, specifically North Dakota Medicaid
• Experience with, and knowledge of, community-based organizations and resources in North Dakota
• Experience with health plans and case management
• Medical/surgical background and a generalized level of understanding across specialty care areas

Skills and Abilities:

• Professional demeanor: Engaging, persistent and assertive. Empathetic, pragmatic, prescriptive
• Excellent interpersonal skills with the demonstrated ability to appropriately simplify medical language into a format understandable to individuals with limited medical background and knowledge
• Strong clinical and documentation skills
• General working knowledge of the healthcare continuum and how various health care services link together including hospital, skilled nursing facilities and community-based services
• Excel in communication with physicians and health care providers
• Ability to use motivational interviewing and active listening skills in member interactions
• Ability to think creatively and be comfortable taking the lead in negotiating and accessing resources
• Ability to have a 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 communication 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 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, MD, ME, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI

The full salary range for this position is $70,700 - $121,200. 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.

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.