UCare

MSS Oversight Manager

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Oct 22, 2021
Closes
Nov 20, 2021
Ref
2619
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 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.

MSS OVERSIGHT MANAGER

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 manage foundational and strategic relationship and regulatory oversight accountabilities that support all aspects of MSS. Serve as a key member of the department and oversight efforts designed to strengthen a culture that promotes collaboration and regulatory readiness. Responsible for interpreting and applying state and federal and NCQA regulatory mandates in performing operational assessments. Responsible for the coordination and administration of a broad scope of MSS program activities, projects and initiatives, including practice management, delegate oversight, clinical liaison activities, and community liaison activities.

• Partner with the members of the MSS Leadership Team to design and implement oversight infrastructure, including processes and tools for administration of the oversight Program. May include helping to ensure the proper design and implementation of internal controls and operating policies and procedures.

• Apply knowledge of State, Federal, and other regulating bodies' to the analysis of internal and delegated practice standards as well as external providers for practice performance feedback.

• Understand the UM and CM processes within UCare and delegated entities in order to oversee and guide their ability to comply with contractual obligations.

• Oversee the development and implementation of auditing tools and strategies to fully analyze the ability to achieve optimal compliance with regulatory standards and meet contractual obligations.

• Oversee completion of corrective action plans and other strategies to monitor the progress of each delegated entity on an ongoing basis. Escalate repeat audit findings, for action. Present findings as directed to delegated entities, MSS, Clinical Services, Provider Relations and Contracting, and other UCare staff as appropriate.

• Oversee the completion of pre-delegation assessments, as necessary, to assure the entity has the capacity and capability to perform delegated functions. Responsibility for the preparation of written reports of assessments and communicate results to leaders and delegated entities.

• Participate in internal and external audits as directed, including identification of universe and gathering of records, file preparation, and provision of information to auditors as requested.

• Coordinate and facilitate meetings with internal and external entities to disseminate information, clarify processes, escalate compliance risk, and ensure corrective action as needed.

• Coordinate and implement compliance audits and other audits as directed, such as interrater reliability audits. Oversee implementation of project plans, statement of work, and/or process flow related to different projects, and be able to prepare results analysis.

• Develop and maintain positive relationships with internal and external entities, in order to increase cooperation and compliance with regulatory requirements and UM and CM processes.

• Oversight of the clinical liaison roles, and their interface with delegates and other key care coordination entities. Facilitation of effective partnerships and innovative strategies to facilitate excellent care to members.

• Oversight of the community liaison team, including the policy liaison, the community liaison, and the housing specialist role.

• Other projects and duties as assigned.

Education

Mental Health Professional or RN with requisite experience. Current and unrestricted license in Minnesota required.

Required Experience

Six years of health care, regulatory experience in the health care industry. Experience working with and interpreting state and federally funded program benefits, including Medicare and Medicaid is required. Experience with health care-related regulatory compliance, auditing, or surveying. NCQA experience

Preferred Experience

Experience with application of NCQA and state regulatory standards to UM processes. Knowledge of provider contracting strategies is highly desirable.

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: 10/21/2021

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