Transplant Case Manager IV

Medica

. Provide member-centered, evidence-based case management across Medicare Advantage, State Public Programs, Commercial, and Individual and Family products .

Posted 9/24/2026full-timeRemote • United StatesMid-LevelSenior💰 $80,700 - $109,535 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management for diverse populations, focusing on member-centered care and effective communication. Proficient in coordinating care across multiple providers and managing complex health issues while ensuring accountability and resource access.

Highest-signal resume keywords

Registered Nurse (RN) LicenseCertified Case Manager (CCM)Clinical/Acute Care ExperienceUtilization Management ExperienceCommunication Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Case ManagementCare CoordinationTransplant Program ManagementHealthcare Continuum KnowledgeDecision-MakingResource NegotiationComplex Issue Management

Soft Skills

Customer ServiceVerbal CommunicationWritten CommunicationGroup Presentation SkillsAdaptability

Tools & Technologies

Computer Systems Management

Certifications & Qualifications

Registered Nurse (RN) LicenseCertified Case Manager (CCM)

Industry Keywords

Medicare AdvantageState Public ProgramsCommercial ProductsIndividual and Family ProductsCommunity Resources

About the role

Key responsibilities & impact

Provide member-centered, evidence-based case management across Medicare Advantage, State Public Programs, Commercial, and Individual and Family products
Serve members with the highest needs and help them navigate the health system telephonically
Understand each member's care goals
Coordinate care across multiple providers
Assist members with finding community resources
Reduce illness burden for individuals and families while decreasing healthcare costs
Ensure members with complex illness are aware of their plan of care
Ensure providers and Medica care management services are aware of the plan of care
Establish care management accountabilities and hold resources accountable
Engage members and provider care teams in care plan discussions
Engage members and families
Design and implement targeted programs

Requirements

What you’ll need

Associate's or Bachelor's degree in Nursing
5+ years of clinical/acute care experience
Current, unrestricted RN license in the state of residence
Certified Case Manager (CCM) preferred, or ability to obtain within two years of hire
Utilization Management / Prior Authorization experience helpful, but not required
Advanced experience in targeted transplant programs
Experience managing multiple computer systems and tools
Experience working with various populations, age groups, ethnic and socioeconomic backgrounds, and medical and surgical backgrounds
Generalized understanding across specialty care areas
General working knowledge of the health care continuum
Strong communication, decision-making, customer service, verbal, and written skills
Ability to present in a group setting
Ability to negotiate and access resources
Ability to work in a fluid, ever-changing, fast-paced environment
Ability to make decisions under stress and manage multiple complex issues daily
Must be legally authorized to work in the United States; Medica does not offer work visa sponsorship

Benefits

Comp & perks

Competitive medical, dental, and vision coverage
PTO
Holidays
Paid volunteer time off
401K contributions
Caregiver services
Other total rewards benefits