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.

UTILIZATION MANAGEMENT MANAGER - MH & SUDS

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 oversee the daily operation of the Mental Health and Substance Use Disorder Utilization Management (UM) team. This position will set priorities for the team to ensure that assigned job duties are completed and assist with updates to the utilization management model based on process improvement strategies, organizational goals, and data. This position will lead recruiting and hiring efforts of all UM staff. This position will provide direct leadership, mentoring, coaching and evaluation of individual staff performance and development needs. In addition, this position will monitor authorization activities, inter-rater reliability (IRR), shaping member care and other quality measures to ensure departmental, contractual, and regulatory requirements are met. This position will collaborate with the Mental Health & Substance Use Disorder Associate Director and other UCare departments to improve daily operations that enable staff to better serve our members and providers.

• Provide oversight of the Mental Health and Substance Use Disorder UM team. Oversee UM training, monitoring, and coaching of team members including maintaining schedules and workflows.

• Participate and facilitate meetings as assigned by the Mental Health and Substance Use Disorder Associate Director. Participate in leadership of the MH and SUD department, taking an active role in setting the course and facilitating progress on department plan initiatives. Serve as a representative on both internal and external committees and/or work groups as assigned by the Mental Health and Substance Use Disorder Associate Director.

• Lead the Mental Health and Substance Use Disorder Utilization Management Workgroup. Monitor the performance of the Mental Health and Substance Use Disorder dashboard and oversee the identification and evaluation of initiatives responding to utilization trends and service costs. Assist with drafting the annual Utilization Management Evaluation.

• Assist with the creation and administration of the annual Utilization Management Provider Survey. Analyze all responses and write an executive summary of the results.

• Lead and establish protocols and processes for management of members/callers in crisis.

• Develop monthly individualized staff reports and dashboards and monitor productivity measures on a regular basis. Ensure daily Utilization Management Specialist adherence to organization and regulatory policies, timelines, and authorization requirements. Provide consistent feedback on performance in a timely manner.

• Coach and provide consultative assistance with all levels of internal/external customers as it relates to regulatory requirements and policies for mental health and substance use disorder services and utilization management. Assist in interpreting policies when providing information and guidance on regulatory obligations to be met. Write and administer the Inter-Rater Reliability test at least annually.

• Lead the efforts around recruitment, interviewing, and hiring of new UM staff. Evaluate and develop training tools and educational materials. Provide and facilitate mentoring of new and existing staff.

• Serve as the hierarchy for UM staff on the review of denial notification letters to confirm determination rational reflects and conforms to regulatory compliance, requirements, and timelines.

• Collaborate with Mental Health and Substance Use Disorder leadership to establish UCare's Mental Health and Substance Use Disorder strategies and work within the organization to develop a work plan to execute on strategies.

• Develop and maintain a comprehensive knowledge of UCare product and member benefits. Understand, implement, and support the Evidence of Coverage, Certificate of Coverage.

• Understand and follow UCare criteria hierarchy for UM. Understand and follow UCare policies and procedures.

• Develop policies, procedures, staffing matrix, and performance standards for UM staff.

• Collaborate with Clinical Services, Quality Management, and other UCare departments to develop integrated care model(s). Collaborate cross departmentally to assist with complex cases that involve mental health or substance use disorders.

• Other projects and duties as assigned.

Education

RN, LP, LPCC, LMFT, or LICSW with requisite experience. Current Minnesota license required.

Required Experience

Five years' experience in Utilization Management across the continuum of health care (managed care organization, inpatient, clinic, outpatient treatment, home care). Three years of supervisory experience. Two years of experience at an inpatient, residential or outpatient mental health or substance use disorder treatment program.

Preferred Experience

Experience with NCQA, state regulatory standards, and Center for Medicaid Medicare Advantage requirements.

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: 11/27/2021

INTERNAL ONLY