This job has now expired
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota’s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We’re an organization that’s going places. Be part of a team that cares about you, be part of UCare.
Working in Provider Relations and Contracting, this position is reponsible for coordinating the provider contracting for regional hospital, professional, vendor and ancillary provider networks, through; contracting, expansion efforts, special initiatives and building and maintaining strong provider relationships. Specific duties and responsibilities include:
- Coordinate the contracting process with regional hospital, professional, vendor and ancillary provider networks including, contract completion and documentation to enable contractual terms are implemented in the system timely and accurately. Work closely with Contracted Networks Manager to coordinate contracting for other provider types.
- Coordinate regularly scheduled meetings with contracted provider networks to provide timely communication, effective education and enhanced provider relationships. Effectively problem solve issues, and transfer issues to Coordinators as appropriate, including but not limited to the following: global claim issues, provider configurations, authorizations, care management and enrollment assignments.
- Assist in the development and maintenance of provider networks to ensure adequate coverage for all products.
- Monitor new and existing provider networks for network adequacy and expansion opportunities, and develop action plans for addressing deficiencies. Initiate and orchestrate provider recruitment, contracting, and related development efforts.
- Collaborate with Provider Enrollment and Configuration (PEC) to resolve contractual issues and articulate the detail needed to load contracts into UCare’s system in a timely and effective manner.
- Monitor providers for fraud, waste and abuse and notify Corporate Compliance of any potential violations.
- Coordinate appropriate internal workgroups to address ongoing provider issues as assigned by supervisor. Includes assessment of issues, development of action plans, implementation and follow up as appropriate.
- Recommend, develop and propose administrative procedures and policies that enhance relationships with providers, enrollees and other UCare customers as needed.
- Assist in compiling monthly, quarterly, and annual departmental metrics and attainment of individual annual goals and departmental goals. Develop and maintain new methods of documenting activities.
- Local and statewide travel required.
This position requires four to six years provider relations or contracting experience in a HMO, commercial health insurance, Medicare or Medicaid health delivery system, large physician practice, or other health care provider setting. Knowledge of managed care operations is also required. Our preferred candidate will have knowledge of local provider systems. A Bachelor's degree or equivalent in health care management, business, or related field, or comparable experience in lieu of degree will be considered.
Knowledge, skills, and abilities required for this role include:
- Demonstrated ability to develop and maintain strong business relationships.
- Ability to manage multiple projects simultaneously.
- Excellent oral, written and interpersonal communication skills.
- Excellent organizational skills.
- Ability to problem solve and prioritize.
- Strong presentation skills.
- Good negotiation skills
- Ability to analyze data and processes.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You’ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis—just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.