Clinical Services Director - Operations

7 days left

Minneapolis, Minnesota
Jul 23, 2020
Oct 05, 2020
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.


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.




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 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 11 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.


Position Description

This position is responsible to strategize, lead and drive key operational aspects within the Clinical Services Department, to include staff orientation & training, cross functional project coordination, Clinical Services Performance Management and Process Improvement, Utilization Review, Intake and Coaching. Provide leadership, direction and support for services to ensure best practices are employed to achieve quality outcomes, reduce/contain costs, and support a high-performance team culture. Additionally, shape policies and interpret the standards required to ensure a high level of member, medical director and external stakeholder satisfaction.

• Provide leadership and mentor to assigned operations area leaders, while team building, ensuring operational preparedness, regulatory compliance, Clinical Service analytics and performance management.

• Support Clinical Services Operation's service areas, clinical systems, analytics and operations.

• Provide back-up coverage in absence of managers/supervisors.

• Oversee day-to-day operational support of the utilization management, intake and health coaching service areas. Consult with the Vice President, Clinical Services and make recommendations for clinical services business functions related to direct report areas.

• Maintain knowledge and understanding of managed care policies, regulatory requirements, and key payer and provider contract provisions as related to clinical systems, utilization management and health coaching.

• Collaborate with clinical services leaders, medical directors and other UCare departments to facilitate effective population-based programming

• Monitor overall utilization management effectiveness, consult with medical directors and other key stakeholders to review and facilitate effective utilization management programming and interventions to ensure medical expense remains within established benchmarks.

• Maintain knowledge of relevant laws (ex: Data Privacy Act), regulations and ensure team updates department and/or organization policies as appropriate.

• Oversee the development of systems, metrics and policies/procedures to meet regulatory requirements (CMS & DHS) and NCQA standards to achieve the goals and business objectives of the Clinical Services area. Ensure application of policies and procedures that support assigned functional areas.

• Create a performance driven programmatic and staff environment, where each area has objective measures for both program improvement and staff success.

• Develop and maintain assigned budgetary responsibilities relevant to primary areas of oversight.

• Lead and/or participate in work groups and committees as assigned.

• Support orientation and ongoing training to facilitate service delivery and professional growth. Prepare staffing matrixes, monitors and manages staff productivity, and revises staffing plan as appropriate.

• Support coordination of projects and process improvement activities as requested by the Vice President, Clinical Services.

• Participate in the selection and orientation of assigned staff to ensure appropriate screening, hiring, and effective selection of staff members.

• Represent UCare as an active member of work groups, sub-committees, interactions with regulators, and special projects. Some travel may be required.

• Participate as a key member of the Clinical Services leadership team and work collaboratively with the Vice President, Clinical Services and Medical Directors to develop the annual department plan.

• Collaborate with Vice President, Clinical Services to strategically advance, implement and evaluate UCare's utilization management programs.

• Ensure utilization management and health coaching quality metrics demonstrate continued improvement in the area of Stars/HEDIS measures and business objectives.

• Collaborate with others to engage staff and corrects course as appropriate related to UCare Staff Engagement survey results. Promote positive employee engagement and appropriate communication with staff.

• Other projects and duties as assigned.


Bachelor's degree in nursing or related field. An unrestricted and current Minnesota licensure in the field of Nursing. Master's degree in business, Nursing, Healthcare Administration or Hospital Administration preferred.

Required Experience

Five years clinical practice experience in a variety of health settings (hospital based, LTC, etc.). Seven years progressively responsible management/supervisory experience that has included analyzing and recommending solutions for development of clinical systems and operations, utilization management and health coaching in a health insurance environment or other affordability/medical management related experience. Comprehensive knowledge of Medicare and Medicaid rules/regulations related to utilization management services.

Preferred Experience

Knowledge of payer utilization management and health coaching models and principles. Project Management; prior background in payer specific clinical systems and data analysis; strong knowledge and acumen regarding business process and clinical operational systems such as Clinical Informatics.


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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