Medica

Manager

• Establish trusting member relationships through active listening, clinical guidance, and timely follow-through
• Connect with members through phone and text outreach on post-discharge and ER follow-up needs, medication adherence needs, and ongoing chronic condition care management
• Assess member health status, coordinate additional resources, and motivate adherence to care plan
• Ensure streamlined support for providers by blending nursing expertise and genuine care
• Support Medica’s Case Management and Quality teams, aligned under Case Management and working closely with Complex Case Management team
• Help drive Quality performance and improve member outcomes
• Conduct regularly scheduled member outreach calls to address utilization gaps
• Coordinate and manage care for members with chronic conditions, including COPD and CHF
• Evaluate and document member health status, risk levels, complication progression, and reasons for non-adherence with care plans
• Provide education, reinforcement, and motivational coaching to reengage member commitment to clinical direction
• Help members secure medications, transportation, specialist referrals, payment support, or other potential socioeconomic barriers to care.

Quality Outreach Case Manager III

Program Manager

• Lead enterprise-wide strategy for CAHPS and HOS performance across Medicare contracts
• Translate CMS Stars methodology and cut point trends into actionable insights and improvement plans
• Partner with leaders across Quality, Stars, Member Engagement, Operations, Marketing, and Member Experience to align initiatives with Medica’s strategic roadmap
• Manage end-to-end CAHPS and HOS program cycles, including survey preparation, vendor coordination, and post-survey analysis
• Oversee timelines, deliverables, and compliance with CMS protocols
• Develop and maintain dashboards, forecasts, and performance tracking tools
• Collaborate with teams across Member Experience, Population Health, Operations, Health Equity, Provider Quality, and Communications
• Facilitate provider engagement strategies to improve member experience and functional health outcomes
• Support internal and external reporting, including Board updates and provider-facing materials
• Monitor and analyze member experience indicators and Medicare CAHPS survey results, identify performance drivers, and lead root cause investigations to ensure goals, objectives, and outcomes are met
• Monitor year-over-year trends, forecast performance against CMS cut points, and recommend targeted interventions
• Translate complex data into executive-level summaries and strategic recommendations
• Work with health plan, providers, and vendors to review best practices, programs, and processes for improvement opportunities.

Quality Outreach Case Manager III

Senior Stars Program Manager