Medical Director

7 days left

Minneapolis, Minnesota
Jul 21, 2021
Oct 31, 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 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.


Work Location: In the office or hybrid (in the office 3 or more days per week)

The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.

Position Description

This position is responsible to conduct day-to-day medical management and lead ongoing improvement in collaboration with CMO and others in Health Services. Provide support and consultation for utilization management (medical and pharmacy), appeals, medical policy (development and maintenance), and quality improvement (Medicare Stars, National Committee for Quality Assurance (NCQA)). Ensure that UCare members receive care that is safe, timely, effective, efficient, patient-centered, and equitable. Support and help to lead aspects of regulatory compliance that relate to clinical functions and programs. Provide clinical support as needed to staff throughout UCare: e.g., complex case management, disease management vendors and delegates. Represent UCare in external forums. Key collaborative relationships: Health Services' leaders and staff.

• Perform medical reviews for determinations of medical necessity, by applying formal clinical criteria that have been adopted by UCare:

o Reviews may be pre-service authorizations, post-service reviews, and appeals.

o Scope encompasses medical and surgical procedures, diagnostic testing, facility admissions and length-of-stay, pharmacy, DME, home care.

o Ensure that workload is distributed fairly among the medical directors and turnaround times are met.

o Document clearly the rationales for clinical decisions, based upon the medical necessity criteria adopted at UCare. Articulate decisions in a manger that is readily understood by medical practitioners and members, is audit-ready, with high inter-rater reliability.

o Conduct peer-to-peer conversations (typically by phone) with practitioners in the community when needed to adjudicate cases.

• Participate in Complex Case Management rounds.

• Participate in committees as assigned. Examples:

External committees:

• Pharmacy and Therapeutic Committee*

• Credentialing Committee*

• Quality Improvement Advisory and Credentialing Committee

Internal UCare committees:

• Medical Policy Committee*

• Health Services Management Committee

• Quality Improvement Committee

*May chair

• Support Pharmacy Department in the development and implementation of formularies, prior authorization criteria and processes, and initiatives to promote safe and cost-effective utilization of pharmaceuticals.

• Investigate instances of possible substandard quality-of-care according to the processes coordinated by the Clinical Services department. Serve as the UCare medical officer who requests a formal response from the responsible provider.

• Collaborate with and support Quality Management to support company-wide clinical quality imperatives: Medicare, Stars, NCQA, Performance Improvement Plans and Quality Improvement Plans.

• Collaborate with and support the staff of Health Services to continuously improve processes.

• Assist in problem-solving and the planning and execution of initiatives that may include the following:

o Improve clinical and service quality for members and providers

o Reduce medical and administrative costs

o Grow membership

o Provider Relations initiatives may involve direct interaction with clinical leadership at provider organizations (specialty groups, provider systems, hospitals).

• Collaborate effectively and provide clinical input when requested by departments outside of Health Services including Health Care Economics, Provider Relations and Contracting, Health Promotions, and Configuration and Claims Operations.

• Represent UCare in matters of health care management and quality of care in external forums: e.g., Minnesota Council of Health Plans, Minnesota Community Measurement, Alliance of Community Health Plans, and America's Health Insurance Plans.

• Other projects and duties as assigned.


Current and unrestricted medical license in Minnesota as a Doctor of Medicine or Doctor of Osteopathy (MD or DO) is required throughout employment at UCare. Current Board Certification in a specialty recognized by the America Board of Medical Specialties (ABMS).

Required Experience

Five years medical practice (after residency). Specialty in Family Medicine, Internal Medicine, Med/Peds, Emergency Medicine.

Preferred Experience

Experience in a managed care organization (health plan, medical management company, ACO network) as a medical director or clinical leader. Demonstrated experience or formally documented education/training in a least two of the following areas, more is highly desirable:

• Quality improvement

• Utilization management

• Complex case management

• Population health

• Clinical practice guideline development and implementation

• Healthcare informatics and analytics

• Social drivers of health


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: 07/20/2021

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