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 600,000 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
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 QUALITY & MATERIAL SPECIALIST
Work Location: Hybrid, Standard and Work From Home
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.
This position is responsible to support the Clinical Services (CLS) department in regulatory and audit activities for CLS member and provider materials. Monitor and communicate regulatory material updates and assist with policy and procedure updates. Serve as a coordinator for the Quality-of-Care review process. Responsible for Quality of Care quarterly and annual reporting. Collaborate across departments and develop strong relationships with all stakeholders. This position requires strong project coordination skills and a thorough knowledge and understanding of regulatory and accreditation standards.
• Participate and assist in regulatory reporting & audit readiness within CLS materials (CMS, DHS/MDH, NCQA) as directed.
• Interpret and coordinate material updates received from internal and external stakeholders.
• Participate in regulatory meetings, workgroups and utilize system tools to effectively capture, update or change current materials.
• Maintain work instructions of the use of internal systems used for materials, policies and procedures and Quality of Care review process.
• Facilitate the Quality-of-Care review process from receipt of complaint through the final steps of member and provider correspondence.
• Assist, research, and/or prepare Quality of Care case investigations and ensure resolution in a timely manner.
• Ensure entry of data requirements and necessary tracking of Quality-of-Care reviews.
• Present Quality of Care data trends and/or updates to leadership and other groups, as assigned.
• Develop work plans, tracking tools, and systems to ensure audit and accreditation readiness for CLS material management.
• Maintain timely communication with leaders regarding Compliance 360 Policy and Procedure updates.
• Participate as subject matter expert in workgroups or projects as assigned, representing Quality and Compliance for Clinical Services.
• Assist with UM Delegate oversight and monitoring as needed.
• Other project and duties as assigned.
Bachelor's degree in business, Information Technology, or related field; demonstrated experience may be considered in lieu of degree.
At least three years of data analysis and report development experience within health plan operations, healthcare provider operations or IT.
Advanced level skill in MS Access and MS Excel with working knowledge of SQL.
Experience working with business Subject Matter Experts to evaluate complex data requirements.
Health Plan Operations experience in Enrollment and/or Membership Billing.
Process improvement, Lean and/or Six Sigma experience.
EDI or API experience.
Health Rules and Axiom experience.
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: 5/5/2022