Clinical Services Operations & Business Systems Analyst

Minneapolis, Minnesota
May 14, 2022
Jun 08, 2022
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 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 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: 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.

Position Description

This position is responsible for working with users for both the utilization management and case management modules of UCare's medical management application. Primary responsibilities will also include working with technical teams on system performance and stabilization to meet the needs of the business users. Identify and analyze system and business process workflow opportunities for continuous improvement. Lead projects to support daily operations and initiatives of the Clinical Services Department (CLS). You will be responsible to support tracking, reporting, analyzing, and summarizing of data. Assist with testing of system changes, including workflow validation and automated processes.

• Monitor operational and performance concerns from users of the medical management application. Analyze real time and historical data and monitor trends to identify opportunities for improved performance, quality, and efficiency.

• Develop and manage Utilization Management (UM) and Care Management (CM) module performance metrics, reports that measure optimization of tool and processes, and identify errors/issues between authorizations crossing over to claims systems.

• Maintain and execute basic and complex data gathering from Guiding Care and Tableau for Clinical Services in terms of application performance and authorization to claims matching resulting in successful adjudication.

• Analyze business processes and provide insights and recommendations for process improvement, leveraging the full functionality afforded through the medical management application.

• Participate in system testing and UAT validation, workflow discussions and participate in cross-functional workgroups.

• Work with users to resolve system errors, troubleshoot, and identify solutions for successful end to end authorization processing into the claims system.

• Lead process improvement efforts and participate in cross- functional projects that impact clinical operations for Clinical Services.

• Participation in annual department projects, regulatory audit readiness, and system upgrades.

• Participate in committees and advisory groups related to UM and CM module within the medical management application.

• Other projects and duties as assigned.


Two years of post-high school education at an accredited college, university, or technical school with a focus in health-related field. Bachelor's degree in health care, computer science, business administration, or related field preferred. Demonstrated experience may be considered in lieu of degree.

Required Experience

At least three years' experience working in a health plan or health care industry experience. At least two years' experience of UM/CM workflows and corresponding applications and reporting and/or analytics experience. Health plan operational experience and knowledge; demonstrated knowledge of health plan federal and state regulatory requirements.

Preferred Experience

Experience working in an HMO or MCO utilization management environment highly desirable. Two years of GuidingCare product and/or user experience. Knowledge of utilization management authorization to claim workflows. Experience leading small to medium cross functional projects in an effort to optimize end to end performance.


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: 5/13/2022

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