Utilization and Affordability Manager

7 days left

Minneapolis, Minnesota
Apr 22, 2021
May 15, 2021
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 for leading the Utilization Management (UM) program operations and clinical review team. Collaborate within Clinical Services and cross-functionally to improve operations to better serve our members and providers. Responsible for strategy development, team initiatives, process improvement, and the development and maintenance of policies and procedures. Interpret and apply state and federal regulatory mandates to support audit readiness and accreditation. Identify, recommend, implement, and communicate affordability opportunities related to Utilization Management.

• Plan, organize, and manage the operations of the UM program.

• Ensure UM program activities meet or exceed requirements set by regulatory agencies, including the Minnesota Department of Health, Minnesota Department of Human Services, Centers for Medicaid and Medicare Services, and the Minnesota Department of Commerce.

• Provide leadership, coaching, mentoring and performance management of UM team, while assuring successful regulatory compliance.

• Develop and lead strategy for the Utilization Management program; establish performance metrics and measure UM program performance.

• Develop and maintain policies, procedures, and performance standards for clinical review staff. Provide leadership and direction to staff including mentoring and coaching as appropriate.

• Represent UM program in internal/ external work groups and initiatives as assigned by the Clinical Services Operations Director.

• Collaborate cross functionally in the development of integrated care models.

• Responsible for UM delegate oversight.

• Identify affordability opportunities and manage medical cost trend initiatives.

• Foster employee engagement and support the values of UCare while delivering on member and provider satisfaction.

• Other projects and duties as assigned.


Bachelor's or Associate Degree or Diploma prepared RN. Current unrestricted Minnesota State Board of Nursing license required.

Required Experience

Three years utilization management experience in a health plan or managed care organization. Five years supervisory or management experience in a health plan, managed care organization, or clinical setting. Knowledge of State and Federal regulations, experience with national accreditation standards. Strong business acumen. Experience with Program ROI measurement and analysis. Experience with developing UM strategy and designing Prior Authorization requirements.

Preferred Experience

Experience with vendor delegation and oversight. Proficiency with Tableau or other reporting tools.


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.

JOB POST DATE: 04/21/2021

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