PMAP/MA Clinical Manager
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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 PMAP Clinical Manager has primary responsibility for the care management staff and daily operations of this team. This position is also responsible for the oversight of UCare’s high-risk obstetric case management program. This role participates as a key contributor in the development and implementation of UCare’s overall care management strategy and aligns the PMAP/Restricted Recipients team with that strategy. Responsibilities include: development and implementation of care models for PMAP and Restricted Recipients populations, daily operational duties including compliance with contractual obligations, staff supervision and mentoring, and ensuring quality care management programming is in place for all products. Specific duties and responsibilities include:
- Oversee the PMAP and Restricted Recipients staff in the performance of care management assessments, development and implementation of care plans, and the evaluation of care outcomes.
- Develop tools and resources to assist care managers in performing their duties, including assessment and care plan documents and algorithms for commonly occurring clinical and psycho-social issues.
- Research, design, and develop care management programs that align with current or future care models for PMAP and Restricted Recipients populations.
- Evaluation and identification of potential Restricted Recipients or PMAP clinical initiatives and development of recommendations for health care outcomes improvement.
- Collaborate with the Quality Management team on HEDIS ratings, Stars Ratings measures, clinical outcome measures, strategies, and interventions.
- Coordinate assignment and allocation of workload to care managers to ensure timely assessment and reassessment of cases.
- Participation in the development of departmental policies and procedures as related to care management and compliance with state and federal regulations.
- Function as the PMAP and Restricted Recipients resource for UCare, care systems, and partners.
- Lead the process of recruiting, interviewing, and selecting of new staff and the mentoring of new employees to include training and integration with other Clinical Services teams.
A bachelor's degree in Nursing with current Minnesota and Wisconsin RN licensure required. Certification in case management desirable. Five years experience in health care industry. One year experience in case management is required. Two years experience supervising professional staff and program development and experience creating and implementing care models is also required. Experience in Prepaid Medical Assistance Programs and/or Restricted Recipients preferred. Experience in Manage Care Organization or commercial insurance desired.
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.