Transplant Case Manager IV

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🔥 0 minutes ago

🌵 Arizona, Florida, +15 more states – Remote

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💵 $80.7k - $109.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

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👻 Ghost score 0%

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Logo of Medica

Medica

1001 - 5000 employees

Founded 1975

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Medica is a nonprofit health plan and insurer with over 50 years of experience that provides individual & family plans, Medicare, Medicaid, and employer-provided health plans. It offers member services and tools for finding providers, managing benefits and claims, wellness programs, and community-focused initiatives through the Medica Foundation to advance health equity.

📋 Description

• Provide member-centered, evidence-based case management across Medicare Advantage, State Public Programs, Commercial, and Individual and Family products • Serve members with the highest needs and help them navigate the health system telephonically • Understand each member's care goals • Coordinate care across multiple providers • Assist members with finding community resources • Reduce illness burden for individuals and families while decreasing healthcare costs • Ensure members with complex illness are aware of their plan of care • Ensure providers and Medica care management services are aware of the plan of care • Establish care management accountabilities and hold resources accountable • Engage members and provider care teams in care plan discussions • Engage members and families • Design and implement targeted programs

🎯 Requirements

• Associate's or Bachelor's degree in Nursing • 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 within two years of hire • Utilization Management / Prior Authorization experience helpful, but not required • Advanced experience in targeted transplant programs • Experience managing multiple computer systems and tools • Experience working with various populations, age groups, ethnic and socioeconomic backgrounds, and medical and surgical backgrounds • Generalized understanding across specialty care areas • General working knowledge of the health care continuum • Strong communication, decision-making, customer service, verbal, and written skills • Ability to present in a group setting • Ability to negotiate and access resources • Ability to work in a fluid, ever-changing, fast-paced environment • Ability to make decisions under stress and manage multiple complex issues daily • Must be legally authorized to work in the United States; Medica does not offer work visa sponsorship

🏖️ Benefits

• Competitive medical, dental, and vision coverage • PTO • Holidays • Paid volunteer time off • 401K contributions • Caregiver services • Other total rewards benefits

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