MH & SUDS Utilization Management Specialist

Minneapolis, Minnesota
Jun 09, 2022
Jul 09, 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 13 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 to coordinate mental health, substance use disorder and social services across the continuum of care to assist members as they work to address their complex mental health and substance use disorder conditions and social service needs. Evaluate member specific clinical information against standardized criteria and regulatory guidelines to determine medical necessity, appropriateness, and efficiency of specific services the organization has targeted for prior authorization and to assess for treatment progress and ongoing needs as part of a concurrent review process. Partner with providers and members to engage, assess, develop, implement, coordinate, monitor and evaluate the member's clinical status to assist with shaping of care and facilitation of a longitudinal treatment plan.

• Complete the continuum of utilization management processes within the established department turnaround times. This includes: initiation and completion of first level medical necessity review; issue organization determination notifications including approvals, denials, terminations, and reductions; and routing service requests to the medical director for physician review. Follow all regulatory guidelines in these processes.

• Assist members in receiving appropriate services for identified needs. Perform telephonic care review for prospective, concurrent and discharge review with mental health and substance use disorder treatment facilities as assigned. Collaborate with members, primary care providers, clinic staff and other relevant agencies to assure appropriateness of service that meets member needs and supports desired outcomes. Facilitate discharge follow up calls post hospitalization with members and verify with their providers completion of follow up appointments.

• Provide consistent and sound first level medical necessity review for published authorization strategies, medical policies, review criteria, review standards, and regulatory requirements in the application of the utilization management process.

• Review initial, concurrent and post service requests for inpatient, residential and outpatient levels of care. Facilitate discharge planning with facilities and members including consideration of any ongoing medical services, as well as MH and SUD services, and resources to address social determinants of health.

• Use clinical judgement to identify service utilization trends and any concerns about delivery of quality services.

• Adhere and understand the regulatory requirements and policies as it relates to mental health and substance use disorder services and utilization management. Apply, interpret and communicate policies, procedures, clinical guidelines, medical policy, regulations and standards.

• Provide information to members and providers regarding mental health and substance use disorder benefits and community treatment resources.

• Facilitate referrals to case management and other UCare programs such as disease management, wellness programs and Intensive Community Based Services to assist with the ongoing management of care needs.

• Meet productivity and quality measures as determined by the department.

• Document clinical activities in accordance with professional licensing board established organizational standards.

• Provide backup coverage to the Mental Health and Substance Use Disorder Triage Line; which includes assisting members in crisis with connection to immediate emergency help and/or community resources. Use of motivational interviewing skills while working with members in crisis. Completion of a crisis assessment tool, safety plan and member follow up. Identification and referral of crisis cases to care management services as appropriate.

• Develop and maintain a comprehensive knowledge of member benefits for each product; understand, implement, and support the Evidence of Coverage, and follow organization policies as they relate to member benefits.

• Collaboration with providers, county staff, social workers and licensed mental health professionals regarding pre-placement and screening for Rule 5 placements.

• Understand and support the organization's provider network and contracts.

• Participate in Holiday Coverage. This includes being on-call over a holiday weekend, review incoming faxes for urgent requests, review and respond to the request, enter authorizations, respond to requests from A&G.

• Other projects and duties as assigned.


RN, LP, LPCC, LMFT or LICSW; preferred dually licensed as a Licensed Alcohol and Drug Counselor (LADC). Current and unrestricted Minnesota license required.

Required Experience

RN: Three years direct mental health and substance use disorder clinical experience. Experience working with Medicaid/Medicare populations and two years in outpatient mental health or substance use treatment facility or two years as staff in an inpatient mental health unit, crisis residential, IRTS, or crisis residential facility.

LP, LPCC, LMFT or LICSW: Three years' experience in mental health and/or substance use treatment. Experience working with Medicaid/Medicare populations.

Preferred Experience

All licensures: Experience in utilization management and/or case management. Knowledge of utilization management standards and experience working with state and federally funded programs. Experience working for an MCO. Training and expertise in Motivational Interviewing skills. Experience in settings that include inpatient, partial, and/or outpatient treatment and care management services in a care management organization.


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: 06/08/2022

Similar jobs

More searches like this

Similar jobs