Supervisor, Restricted Recipient Program (Case Management)

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

This position is accountable for the day to day operational support and strategic activities of the assigned team. This position is also accountable for achieving department objectives and maintaining flexibility to meet business needs. Responsibilities include supervision of the clinical and non-clinical team members, ensuring that the strategic and business processes are established, maintained and communicated, and effective interdepartmental communications are established. Participate in planning, implementation and evaluation of the restricted recipient program to ensure quality services and compliance with all regulatory and contractual requirements. This position resides in the Health Services department yet interacts regularly with other areas within Medica.

In addition to the coaching and staff development responsibilities, the Restricted Recipient Program Supervisor must also build strong relationships with internal and external partners. More specifically, support the Director or Manager, Case Management in relationship building within Medica and its vendor partners to help prioritize, integrate and coordinate interventions for population segments based on medical, behavioral and social needs.

This role oversees case management projects, initiates and participates in quality improvement activities, and performs data monitoring of utilization activity for reporting to internal customers. Performs other duties as assigned.

Key Accountabilities

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  Supervise and Maintain Efficient Department Operational Systems/Process

  
  
  
  
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    Comply with policy and procedures effectively and with appropriate documentation and ensure team meets all department, regulatory and contractual requirements and goals.

    
    
  • Informs the Manager/Director of process, procedure, policy and other issues that cannot be resolved within the team.
  • Model change management philosophies and support and facilitate a positive approach to change among team members.
  • Monitor team members' calls and casework to ensure staff is following department guidelines, processes and turn-around times.
  • Manage performance and hold staff accountable for meeting department standards for quality, turn around times, policy application, effectiveness, attendance, and personnel management, etc. Formulate action plan for less than acceptable performance.
  • Consult human resources and Manager/Director to ensure compliance with company policies and values.
  • Responsible for personnel management including interview process, goals establishment, performance review, and team-building.
  • Assist with delivery of new employee orientation programs for team members, and contributes to the development, maintenance and communication of educational programs as indicated.
  • Compile and report team and individual statistics for planning and evaluation.
  • Assist the Manager/Director to define and utilize performance standard to monitor staff performance.
  • Accountable for driving performance toward goals and communicating effectively to peers when process gaps are impeding goals.
  
  
  
  

• Manage Performance of Restricted Recipient Team

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  • Leads and supervises the program and team as outlined under the Position Overview section.
  • Ensures that the coordinators successfully meet and exceed process-oriented outcomes.
  • Assess the training and development needs of each new employee to result in fully competent performance within one year. Assess existing employees for training and development needs or performance improvement plans.
  • Provide team members with ongoing and consistent feedback, directed toward clinical excellence and accountability to department goals.
  • Regularly assess and measure team workload and staffing ratios, ensure workload is evenly distributed. Develop and implement plan for backlog situations when needed. Communicate workload and turn-around times.
  • Coach, encourage and facilitate individual growth and development through specific, timely and consistent feedback. Conduct regular and timely one on one meeting.
  • Ensure timeliness and accuracy of all required administrative functions, i.e. timecards, performance evaluations, call recordings, expense reports, etc.
  • Communicate management decisions in a positive manner to staff.
  • Accessible during workday to facilitate problem solving and resolution of case review issues and complaints.
  • Take phone calls, handle escalated issues, and provide a setting for clinical case consultations.
  • Provide technical and clinical support to staff by researching and responding to their questions.
  • Coach staff on the Quality Audit results. Recommendations from audits are evaluated and appropriate improvement measures are taken.
    
  
  
  
  
• Project and Group Management and Industry Knowledge

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    Work closely with project management team on implementation of new and renewing clients and for new and ongoing company and department initiatives.

    
    
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    Exhibit skills in organization, project management, time management and meeting facilitation.

    
    
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    Assist in the development, implementation or maintenance of department programs, which reflect quality of service and care as delegated by the manager.

    
    
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    Represent the Restricted Recipient program at interdepartmental meetings and committees.

    
    
  
  
  
  

• Establish and Maintain Positive Relationships with Internal and External Customers

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    Assist in developing and maintaining strong, positive and open relationships with other internal and external stakeholders.

    
    
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    Listen to and understand customer's questions, concerns or problems.

    
    
  
  
  
  

Required Qualifications

• Associate's or Bachelor's degree in Nursing
• 5+ years of related work experience beyond degree
• 1+ years in leadership

Required Certifications/Licensure

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  Active, unrestricted RN License or SW License in the state of MN Required

  
  
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  Certified Case Manager (CCM) preferred, or ability and commitment to obtain within two years of hire.

  
  

Preferred Qualifications

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  Experience working with vulnerable and complex populations in a clinical, home care or telephonic environment; direct case management experience strongly preferred.

  
  
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  Experience and at ease working with various populations: multiple age groups, ethnic and socioeconomic backgrounds, medical, surgical backgrounds and a generalized level of understanding across specialty care areas. Experience managing multiple computer systems and tools.

  
  
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  Proven experience in case management, healthcare operations, or a related field.

  
  
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  Strong leadership, coaching, and team development skills.

  
  

This position is an Office role, which requires an employee to work onsite at our Minnetonka, MN office, on average, 3 days per week.

The full salary grade for this position is $78,700 - $134,900. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $78,700 - $118,020. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.