Medica

Care Coordinator III RN

Medica · Full Time · a day ago

Medica

🌎 United States 💵 $72100 - $97850 per year ⭐ 2-5 yrs exp 💼 Healthcare

Care Coordinators manage a caseload of members to create individualized care plans and coordinate the delivery of medical and social services. They also provide education on benefits and serve as a primary contact for members while partnering with providers and county entities.

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Appeals and Grievances Clinical Specialist III

Medica · Full Time · 4 days ago

Medica

🌎 United States 💵 $70200 - $105K per year ⭐ 5-10 yrs exp 💼 Healthcare

The specialist is responsible for the clinical review, investigation, and resolution of member and provider appeals and grievances. They collaborate with medical directors and operational teams to ensure regulatory compliance and support quality performance outcomes.

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Coding Analyst

Medica · Full Time · 11 days ago

Medica

🌎 United States 💵 $45900 - $78600 per year ⭐ 2-5 yrs exp 💼 Others

Perform high-level medical coding, audits, and analysis to ensure accurate claims processing and provider reimbursement. Serve as a subject matter expert for coding-related inquiries and maintain medical code sets within company systems.

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Customer Service Representative - Government Products (8/31 Start Date)

Medica · Full Time · 13 days ago

Medica

🌎 United States 💵 $33300 - $41370 per year ⭐ 2-5 yrs exp 💼 Support

Act as the primary contact for members to resolve inquiries regarding claims, enrollment, billing, and pharmacy benefits. Provide high-quality service and utilize the service recovery process to assist members in complex situations.

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Appeals & Grievances Quality Auditor

Medica · Full Time · 14 days ago

Medica

🌎 United States 💵 $56600 - $97000 per year ⭐ 5-10 yrs exp 💼 Finance

Conduct routine and targeted audits of appeals and grievances cases to ensure compliance with federal, state, and organizational regulations. Analyze audit results to identify trends and partner with leadership to implement corrective action plans and quality improvements.

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Customer Service Representative - Commercial Products (8/31 Start Date)

Medica · Full Time · a month ago

Medica

🌎 United States 💵 $33300 - $41370 per year ⭐ 2-5 yrs exp 💼 Support

Act as the primary contact for members to resolve inquiries regarding claims, enrollment, billing, and pharmacy benefits. Utilize the service recovery process to assist members in complex situations and ensure high levels of service satisfaction.

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Care Coordinator II or III RN or Licensed SW (All Counties in MN)

Medica · Full Time · a month ago

Medica

🌎 United States 💵 $62700 - $107K per year ⭐ 5-10 yrs exp 💼 Healthcare

Manage a caseload of members to create individualized care plans and coordinate medical and social services. Partner with physicians and county entities to provide education on Medicare and Medicaid benefits.

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Utilization Management RN III

Medica · Full Time · a month ago

Medica

🌎 United States 💵 $70200 - $120K per year ⭐ 5-10 yrs exp 💼 Healthcare

The role involves reviewing and documenting prior authorization requests and member case histories to determine coverage approval. Additionally, the nurse analyzes trends to recommend revisions to medical policies and utilization management procedures.

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Medical Director – Clinical Ops Case Review - NEX

Medica · Full Time · a month ago

Medica

🌎 United States 💵 $235K - $403K per year ⭐ 10+ yrs exp 💼 Healthcare

The Medical Director supports clinical operations by performing medical necessity and appeal case reviews for care management. They are also responsible for chairing the Technology Assessment Committee and developing medical policies that balance provider, patient, and health plan interests.

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Sales Relationship Manager

Medica · Full Time · 3 months ago

Medica

🌎 United States 💵 $73500 - $126K per year ⭐ 5-10 yrs exp 💼 Sales

Drive new business sales by managing strategic relationships with brokers and consultants for commercial large group business. Develop strategic sales plans and lead RFP responses to provide tailored healthcare solutions for clients.

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