UCare

Credentialing Delegated Coordinator

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Jul 26, 2018
Closes
Sep 27, 2018
Category
Healthcare
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 UCARE

At 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 UCARE

Working 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.

 

CREDENTIALING DELEGATED COORDINATOR

 

Position Description

This position is responsible for implementing, coordinating and evaluating the delegated credentialing process including; communication with delegated contacts, conducting annual audits, data entry of delegate profiles, and monthly monitoring assuring delegated activities meet all regulatory and accreditation requirements based on legislative mandates and company strategic direction.  Specific duties and responsibilities include:

 

Identify, schedule, and conduct audits on delegated credentialing contracted entities.  Provide recommendation on delegation status based on current audit with UCare to appropriate leadership.

Assist Quality Operations Associate Director to develop and maintain delegation agreements.  Obtains legal review as needed.   

Ensure delegated entities maintain compliance with UCare's Credentialing Plan as well as the National Committee on Quality Assurance (NCQA), Center for Medicare and Medicaid Services (CMS), and the Minnesota Department of Health (DHS).

Coordinate bi-annual meetings with the delegates to discuss any issues, educate and implement new processes when policies change or when accreditation or regulatory standards change.  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.

Analyze and maintain provider data entered in the credentialing database to ensure accuracy for members in Find A Doc and directories.

Assist in development and implementation of delegation data entry work instructions, tools policies and procedures.

Remain current with credentialing requirements mandated by external review agencies (e.g., NCQA, The Joint Commission) and/or state and federal regulations.  Collaborate with leader to modify delegation processes to ensure continued compliance with such requirements.

Analyze, prepare and present delegation oversight reports and delegated practitioners who do not meet UCare's credentialing criteria to the Credentialing Committee.

Collaborate with other health plans as part of the MN Council of Health Plans Delegation Collaboration. This includes active participation and follow all policies and procedures related to the collaborative.

Provide recommendations to the Quality Operations Associate Director and the UCare Credentialing Committee whether to delegate credentialing per annual audit results.

Other projects and duties as assigned. 

Education

Bachelor's degree and two years managed care; demonstrated experience in managed care or in a health care credentialing setting may be considered in lieu of degree or High School Diploma/GED and five years managed care.  Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator Certification required.

Required Experience

Experience with implementing NCQA and JCAHO credentialing standards. Knowledge of delegated credentialing activities and processes.

Preferred Experience

Previous training experience.

 

THE UCARE DIFFERENCE

UCare 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.

Rewards

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.
www.ucare.org/careers/
EOE/AA

Similar jobs

More searches like this

Similar jobs