UCare

MSS Regulatory Specialist

7 days left

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Oct 30, 2021
Closes
Dec 12, 2021
Ref
2620
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 REGULATORY SPECIALIST

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 for leading the MSS team in regulatory audits, accreditation surveys and staying regulatory ready and continuously compliant. Serve as the NCQA business owner designee as assigned at internal committees and/or work groups. Collaborate across departments and develop strong relationships with all stakeholders. This position requires strong project management skills and thorough knowledge and understanding of NCQA standards.

• Lead the coordination of the NCQA accreditation processes for MSS including; coordination of assigning standards, monitoring and measuring progress, and ensuring evidentiary documentation is submitted within established time frames. Ensure successful preparation for file review.

• Participate and assist in regulatory reporting & audits (CMS, DHS, MDH, NCQA) including those which are applicable to specific products such as SNP, Family and Children's, IFP, Medicare as well as specialized and highly regulated programs such as RRP.

• Update UM program description and evaluation, including for the BPO product.

• Write and evaluate model of care document and annual evaluation of outcome measures.

• Oversight of Parity compliance - keeping evaluation documents up to date and coordinating with stakeholders throughout the organization.

• Lead MSS mock audits for NCQA file review, annual delegate care management & delegate utilization management audits.

• Develop work plans, tracking tools, and systems to ensure survey readiness utilizing project management tools and resources.

• Maintain timely communication with leaders regarding Compliance 360 emails.

• Participate as subject matter expert in workgroups or projects as directed by the Oversight Manager.

• Other projects and duties as assigned.

Education

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

Required Experience

Three years or more experience in a managed care organization, quality management program in a health care setting or other related experience. NCQA experience.

Preferred Experience

Experience in project management, accreditation survey preparation process, data collection, report writing, and basic data analytic skills.

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

Similar jobs

More searches like this

Similar jobs