UCare

Behavioral Health Utilzation Review Supervisor

7 days left

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Jul 12, 2019
Closes
Aug 26, 2019
Ref
1654
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.

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

ABOUT UCARE

UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE

Working at UCare is more than 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. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 10 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

BEHAVIORAL HEALTH UTILIZATION REVIEW SUPERVISOR

Position Description

This position is responsible to oversee the daily operation of the Behavioral Health Utilization Review Specialists. Participate in recruiting and hiring of behavioral health staff. Collaborate with Behavioral Health Manager in evaluation of staff performance, planning staff education and mentoring. Monitor authorization activities, inter-rater reliability (IRR), and other quality measures to ensure contractual and regulatory requirements are met. Collaborate cross departmentally to assist with complex cases that involve behavioral health. Create, review, analyze and interpret data collection from multiple sources and assist with maintaining department policies and procedures. Facilitate connecting members with appropriate behavioral health services.

• Supervise and provide oversight of Behavioral Health Utilization Review Specialists. Oversee UR training, daily compliance monitoring and coaching of team members including maintaining schedules and workflows. Manages engagement-related efforts and assignments of staff with varying degrees of expertise and experiences. Provide backup to staff as needed.

• Lead and establish protocols and processes for management of members/callers in crisis.

• Develop monthly individualized staff reports and dashboards and monitor productivity measures on a regular basis. Ensure daily Utilization Review Specialist adherence to organization and regulatory policies, timelines, and authorization requirements. Provide consistent feedback on performance in a timely manner. Discuss with staff during 1:1's.

• Develop protocols for reporting quality of care concerns, sentinel events and other reporting needs and present information to appropriate teams.

• Coach and provide consultative skills with all levels of internal/external customers as it relates to regulatory requirements and policies of behavioral health services and utilization review. Assist in interpreting policies when providing information and guidance on regulatory obligations to be met.

• Collaborate with Behavioral Health Manager on recruitment, interviewing, and hiring of new staff. Evaluate and develop training tools and educational materials. Provide and facilitate mentoring of new and existing staff.

• Serve as the hierarchy for Utilization Review staff on the review of denial notification letters to confirm determination rational reflects and conforms to regulatory compliance, requirements and timelines.

• Develop and maintain a comprehensive knowledge of UCare product and member benefits. Understand, implement, and support the Evidence of Coverage, Certificate of Coverage.

• Understand and follow UCare criteria hierarchy of utilization review. Understand and follow UCare policies and procedures.

• Identify gaps in Behavioral Health InterQual, Medicare, Medical Assistance, and UCare Medical Policy.

• Monitor, process and report MACESS aging. Monitor team queue mailboxes to ensure compliance with departmental service level agreements.

• Collaborate with Behavioral Health Manager to evaluate, develop, and implement behavioral health care management models to ensure collaboration and continuity between UR and CM staff.

• Other projects and duties as assigned.

Education

RN, LP, LPCC, LMFT, or LICSW with requisite experience. Current Minnesota license required.

Required Experience

Three years of Behavioral Health Utilization Review experience. Five years of Behavioral health clinical experience.

Preferred Experience

One year of supervisory experience. Experience with NCQA, state regulatory standards, and Center for Medicaid Medicare Advantage requirements. Behavioral Health case management experience.

THE UCARE DIFFERENCE

The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, 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.

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