Quality Outreach Case Manager III

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.

Medica’s Quality Outreach Case Manager works to establish trusting member relationships through active listening, clinical guidance and timely follow-through to improve health and quality outcomes. The Quality Outreach Case Manager routinely connects with members through phone and text outreach on post-discharge and ER follow-up needs, medication adherence needs, and ongoing chronic condition care management. Using member-centered discussion, the Quality Outreach Case Manager assesses member health status, coordinates additional resources and motivates them to adhere to their care plan. The Quality Outreach Case Manager also ensures streamlined support for our providers by blending their nursing expertise and genuine care, helping to get high-need members back on track. This is a highly collaborative role that is positioned to support Medica’s Case Management and Quality teams. This role will be aligned under Case Management and will work closely alongside the Complex Case Management team to support quality initiatives. A successful Quality Outreach Case Manager is driven by connection—energized by helping members, collaborating with care teams, and supporting providers. Whether it’s scheduling an eye exam, coordinating care, or ensuring medications are filled, they excel at making a difference through meaningful relationships and proactive outreach. The Quality Outreach Case Manager seeks to help drive Quality performance and improve member outcomes. The Quality Outreach Case Manager is skilled at telephonic work, including navigation of the health plan and community providers and facilities. This includes having exceptional skills in organization, prioritization, problem solving, and autonomy. Interpersonal and external provider/care system relationship skills are essential. Maintaining a strong working knowledge of numerous Medica sponsored and external health programs and services is also required. Performs other duties as assigned.

Conducting regularly scheduled member outreach calls to address utilization gaps including post-discharge follow up, frequent ER use and medication adherence issues. Coordinate and manage care for members with chronic conditions, including COPD and CHF. Evaluating and documenting member health status, risk levels, complication progression and reasons for non-adherence with care plans. Providing education, reinforcement and motivational coaching to reengage member commitment to clinical direction. Helping members secure medications, transportation, specialist referrals, payment support or other potential socioeconomic barriers to care. Serving as point-of-contact for assigned members, building trusted relationships that promote accountability to reach care benchmarks. Provide guidance, input and support to Quality and Clinical leadership as they develop and improve programs and outreach