MSHO/MSC+ Case Manager
- Employment Status
- Full Time
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. MSHO/MSC+ CASE MANAGER Position DescriptionThis position is responsible to coordinate services across the continuum of health care to meet the health and/or social service needs of members in Government plan products as assigned. Coordinate member services with appropriate primary care clinics/providers, care systems, specialists, clinic, county, and UCare personnel to achieve the most appropriate and cost-effective member care to optimize the long term health of the member. Specific duties and responsibilities include: Collaborate with treatment providers, county and community agencies, and contracted and non-contracted providers to identify and coordinate provision of health care services for Government plan product members. Appropriately apply case management criteria, protocols and procedures.Understand and accurately interpret and apply relevant contractual requirements, policies, procedures and regulations for members which care management is a provided service.Collaborate with members and/or family members, primary care physicians, clinic staff, providers, and other relevant agencies to assure appropriateness of service that meets member needs and ensures desired outcomes.Complete comprehensive assessment of assigned members. Appropriately utilize interpreter services as needed. Identify and monitor member needs, including needed preventive medical care, and significant changes in condition which may warrant early intervention for medical problems. Develop care plans to meet each member's individual needs. Incorporate ethnic and culturally appropriate approaches to care planning.Present information on assigned members at assessment conferences and case reviews as appropriate. Enter member information in the clinical documentation system, Care Enhance Clinical Management (CCMS) software. Complete accurate, thorough and timely required documentation.Meet and maintain all established caseload and performance metrics. Ensure safe transitions when members move from one setting to another (i.e. being discharged from a hospital or skilled nursing facility). Ensure the plan of care is communicated between the sending and receiving settings for both planned and unplanned transitions. Support members and member families through care transitions between various facilities, acute and/or chronic settings, and community-based living situations including home.Use appropriate communication tools per contractual and care model requirements.Monitor and report all quality of care issues through the appropriate internal or external systems.Assist with CMS Star Rating initiatives or HEDIS quality initiatives and project improvement planning as appropriate.Attend internal and external meetings, including staff meeting, discharge planning conferences, community meetings.Provide back-up coverage for other care managers as assigned.Other projects and duties as assigned. EducationB.S. in nursing or B.A. in social work or related field. Registered Nurse with a nursing diploma (3 year program) or associate degree in nursing with five or more years experience also considered. Current Minnesota license as an RN or social worker is required. Licensure requirements may depend on assigned product(s). Required ExperienceTwo year's experience in care coordination/case management across the continuum of health care (hospital, clinic, nursing home, home care etc.) with primary emphasis in working with complex social and medical problems.Preferred ExperienceManaged care experience, experience with government programs, particularly Medicare, Medicaid and other State Public Programs. Experience working with multi-cultural populations desired. THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 9th 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.