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 12 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.

CLINICAL SERVICES DIRECTOR - CARE MANAGEMENT

Position Description

This position is responsible to complete complex tasks and make decisions within broad parameters with minimal supervision. Responsible for the development and implementation of care management programs and services. Provide leadership, direction and support for care management services to ensure best practice is employed to achieve quality outcomes, reduce/contain costs, and shape and interpret the standards required to ensure a high level of member and medical director satisfaction and a high degree of employee engagement. This position has responsibilities for multiple entity-specific oversight and relationship management, contractual deliverables, and connections with community agencies. Additional oversight is provided for delegate education & training and delegate communication.

• Provide leadership and mentoring to care management staff and leaders while ensuring regulatory compliance. Support performance management of staff.

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

• Assist with overseeing the day-to-day administration and management of care management services including vendors. Consult with Vice President, Clinical Services and make recommendations related to care management business functions.

• Maintain knowledge and understanding of managed care policies, regulatory requirements, and key payor and provider contract provisions as related to care management.

• Collaborate with care management leaders and medical directors to facilitate effective care management programming and ensures interventions are employed and that complex cases are reviewed and managed.

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

• Maintain knowledge of applicable laws such as Data Privacy Act, regulations, and departmental or organization policies.

• Oversee the development of systems and care management policies/procedures to meet regulatory requirements (CMS & DHS) and NCQA standards. Ensure the application of policies and procedures support care management functions.

• Develop and maintain assigned budgetary responsibilities relevant to care management services.

• Chair and/or participate in work groups, committees and external partnerships as assigned.

• Ensure orientation and ongoing training as needed to facilitate service delivery and professional growth. Prepare staffing matrixes, monitor, and manage staff productivity, and revise staffing & training plan as appropriate.

• Ensure coordination of care management services with other areas through Clinical Services, MSS, Pharmacy and Quality Management.

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

• Routinely represent UCare as an active member of community committees, work groups, regional sub-committees, interactions with counties, and special projects. Some travel may be required.

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

• Formulate, implement, and evaluate UCare's care management programs. Actively lead care management teams in the review of current care models, the research and development of new models, and implementation of care model changes. This includes management of clinical practice guidelines.

• Ensure care management quality metrics demonstrate continued improvement in the area of Stars/HEDIS measures and care management program performance metrics demonstrate continued improvement in utilization and savings.

• 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.

• Evaluate member satisfaction with care management functions and services through annual satisfaction surveys.

• Other projects and duties as assigned.

Education

Bachelor's Degree in nursing, social work, counseling, or closely related field. Associate Degree may be considered with demonstrated experience. A current unrestricted Minnesota licensure in field of study (as appropriate).

Required Experience

Five years clinical practice experience in a health setting. Seven years progressively responsible management/supervisory experience that has included analyzing and recommending solutions for development of care management services. Comprehensive knowledge of Medicare and Medicaid rules/regulations related to care management services.

Preferred Experience

Knowledge of chronic illness and case management models and principles. Certificate in Case Management

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.

JOB POST DATE: 04/21/2021