Restricted Recipient Coordinator
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.
The Restricted Recipient Coordinator is responsible for the coordination of health care services for members enrolled in the Minnesota Restricted Recipient Program (MRRP). This includes coordination of health care services for members with the designated primary care clinics/providers, specialists, hospital and pharmacy according to contracts and program requirements as defined by DHS, and MN statute. Specific duties and responsibilties include:
- Collaborate with designated providers, county and community agencies, and contracted and non-contracted providers to identify and coordinate provision of health care services for state program members enrolled in MRRP.
- Understand and accurately interpret and apply relevant contractual requirements, policies, procedures and regulations for members enrolled the MRRP.
- Conduct investigation for both potential member enrollment and re-enrollment in the MRRP; collaborate with UCare medical directors to implement member restriction; issue appropriate MRRP notices and appeal rights.
- Monitor and track member compliance with program rules.
- Collaborate with DHS and other MCO's as needed to obtain pertinent information related to previous or current restriction status, program compliance and claims data.
- Document review activities including all member and provider communication in accordance with professional nursing/social work and established organizational standards in CareEnhance Clinical Management (CCMS) software.
- Review member claims for appropriate utilization and respond to claims inquiries for payment directives in Macess.
- Develop a plan of care with each MRRP member. The plan of care is shared with the member and documented in CCMS.
Registered Nurse (BSN preferred) or Social Worker with current Minnesota license is required. A minimum of two years experience in care coordination, case management, or utilization management across the continuum of health care (hospital, clinic, home care etc.) is required. Previous managed care experience with restricted member programs and/or special investigation units is preferred. Experience working in mental health or chemical dependency programs highly desired. Knowledge of pharmaceutical drug categories is helpful.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve. EOE/AA
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.