Manage a specified caseload of senior members and individuals with disabilities to create individualized care plans. Coordinate the delivery of medical and social services while partnering with physicians and county entities.
Medica
10 Remote Job Openings at Medica
The Case Manager III provides member-centered, evidence-based care to ensure safe transitions between care settings. Responsibilities include assessing care goals, coordinating medical services, and connecting members with community resources to reduce illness burden and costs.
Provide member-centric, evidence-based care for high-needs members to navigate the healthcare system and ensure safe transitions. Coordinate services across various settings and connect members with community resources to reduce the burden of illness.
Customer Service Representative - Commercial Products (8/31 Start Date)
Medica
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Full Time
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7 days ago
Medica
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.
Customer Service Representative - Government Products (8/31 Start Date)
Medica
·
Full Time
·
7 days ago
Medica
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.
Care Coordinator II or III RN or Licensed SW (All Counties in MN)
Medica
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Full Time
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7 days ago
Medica
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.
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.
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.
The specialist is responsible for requesting, retrieving, and validating medical records from providers to support clinical reviews and regulatory audits. They manage data tracking, ensure PHI compliance, and coordinate with internal teams to resolve documentation gaps.
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.
