Case Manager - Commercial Insurance (Choices)
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.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. CARE MANAGER - Commercial Insurance (Choices) Position DescriptionThis position is primarily responsible to implement UCare's NCQA compliant Complex Case Management Program and care transitions across the continuum of health care. This involves telephonic case management to collaborate with the UCare member and/or family member and interdisciplinary team to support the member's complex medical needs. Specific duties and responsibilities include: Provide telephonic case management.Implement UCare's NCQA Complex Case Management program as well as other case management initiatives. Understand and accurately interpret and apply relevant contractual requirements, policies, procedures and regulations for those members for which care management is a provided service. Collaborate with members and/or family member, primary care providers, clinic staff and other relevant agencies to assure appropriateness of service that meets member needs and supports desired outcomes. Complete assessment of assigned members. Collaborate with member/caregiver in the development of a care plan appropriate to the member's needs. Identify and monitor member needs, including needed preventive medical care, and significant change in condition which may warrant early intervention for medical problems, or transitions of care. Incorporate ethnic and culturally appropriate approaches to care planning as needed. Enter member information in the CareEnhance Clinical Management (CCMS) software. Documentation is accurate, thorough and timely. Meet and maintain all established caseload and performance metrics. Attend internal and external meetings; may act as team representative on cross departmental meetings as assigned. Assist with CMS Star Rating initiatives and other project improvement planning as appropriate. Other projects and duties as assigned.EducationRegistered Nurse (BSN preferred). Current unrestricted RN license in Minnesota required.Required ExperienceTwo years experience in care coordination/case management across the continuum of health care (hospital, clinic, nursing home, home care etc.) with primary emphasis working with chronic medical conditions.Preferred ExperienceManaged care or commercial experience. NCQA Complex Case Management preferred. THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 7th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
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.