Restricted Recipient Coordinator

Minneapolis, Minnesota
Apr 19, 2019
May 01, 2019
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.


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 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.


Position Description

This position is responsible to coordinate health care services for members enrolled in the Minnesota Restricted Recipient Program (MRRP) the CMS Opioid Monitoring Program (OMP) and the Exchange Restricted Member Program (ERMP). 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 CMS, DHS, MN statute and the Choices Member Contract, Section: “Harmful Use of Services”.

·Collaborate with designated providers, county and community agencies, contracted and non-contracted providers to identify and coordinate provision of health care services for UCare members enrolled in a restricted or monitoring program.

·Understand and accurately interpret and apply relevant contractual requirements, policies, procedures and regulations for members enrolled a restricted or monitoring program

·Conduct investigation for both potential member enrollment and re-enrollment in a restricted or monitoring program; issue appropriate restricted or monitoring program 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 clinical documentation system.

·Review member claims for appropriate utilization and respond to claims inquiries for payment directives in Macess.

·Maintain compliance with all regulatory rules and timelines pertaining to the restricted or monitoring program.

·Other projects and duties as assigned.


Registered Nurse (BSN preferred) or Social Worker; current and unrestricted Minnesota license is required. 

Required Experience

Two years' experience in care coordination, case management, or utilization management across the continuum of health care (hospital, clinic, home care etc.).

Preferred Experience

Previous managed care experience with restricted member programs and/or special investigation units preferred. Experience working in mental health or chemical dependency programs highly desired.  Knowledge of pharmaceutical drug categories is helpful.


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.




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.

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