Quality Outreach Case Manager III
Medica
full-time
Posted on:
Location Type: Remote
Location: Remote • Arizona, Florida, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Minnesota, Missouri, Montana, New York, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Virginia, Wisconsin • 🇺🇸 United States
Visit company websiteSalary
💰 $70,700 - $95,950 per year
Job Level
Mid-LevelSenior
About the role
- 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.
Requirements
- Associate or bachelor’s degree in nursing
- 5+ years of clinical/acute care nursing experience with focus in chronic condition management, post-acute, utilization management, or case management preferred
- Current, unrestricted RN license in the state of residence
- Certified Case Manager (CCM) preferred, or ability and commitment to obtain within two years of hire
- Experience working with vulnerable and complex populations, including multiple age groups, ethnic and socioeconomic backgrounds provided in a clinical, home care or telephonic environment; direct case management experience strongly preferred
- Knowledge of managed care principles and regulatory guidelines preferred
- Proficiency in electronic health records and care management software
- Familiarity and understanding of healthcare quality improvement standards and principles including HEDIS, Gaps in Care, STARs, and the impact from a health plan perspective.
Benefits
- Health insurance
- Dental insurance
- Vision insurance
- Paid time off
- Holidays
- Paid volunteer time off
- 401K contributions
- Caregiver services
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical guidancechronic condition managementutilization managementcase managementhealth status assessmentmedication adherencecare plan evaluationmotivational coachingsocioeconomic barrier identification
Soft skills
active listeningtrust buildingcommunicationempathymotivation
Certifications
RN licenseCertified Case Manager (CCM)