Transplant Case Manager IV

This is a fully remote position, open to applicants in Arizona, +16 more states.

📋 Description

• Deliver member-focused, evidence-informed case management across Medicare Advantage, State Public Programs, Commercial, and Individual and Family offerings.

• Assist members with significant needs in navigating the healthcare system via telephone.

• Comprehend each member's healthcare objectives.

• Facilitate care coordination among various providers.

• Aid members in locating community resources.

• Mitigate the burden of illness for individuals and families while lowering healthcare expenses.

• Ensure that members with complex illnesses are informed about their care plans.

• Make certain that providers and Medica care management services understand the care plan.

• Set care management responsibilities and hold resources accountable.

• Involve members and provider care teams in discussions about care plans.

• Engage both members and their families.

• Create and execute targeted programs.

⛳️ Requirements

• Associate's or Bachelor's degree in Nursing.

• Over 5 years of clinical/acute care experience.

• Current, unrestricted RN license in the state of residence.

• Certified Case Manager (CCM) preferred, or the ability to achieve certification within two years of employment.

• Experience in Utilization Management / Prior Authorization is advantageous but not mandatory.

• Advanced knowledge in targeted transplant programs.

• Proficient in managing multiple computer systems and tools.

• Experience working with diverse populations, age groups, ethnicities, socioeconomic statuses, and medical/surgical backgrounds.

• Broad understanding of various specialty care areas.

• General knowledge of the healthcare continuum.

• Excellent communication, decision-making, customer service, verbal, and written skills.

• Capability to present in group settings.

• Ability to negotiate and access resources.

• Competence to thrive in a dynamic, rapidly evolving environment.

• Capacity to make decisions under pressure and handle multiple complex issues daily.

• Must possess legal authorization to work in the United States; Medica does not provide work visa sponsorship.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage.

• Paid time off (PTO).

• Holiday pay.

• Paid volunteer time off.

• 401K contributions.

• Caregiver services.

• Additional total rewards benefits.