UCare

Clinical Services Oversight & Compliance Sr. Manager

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Jun 30, 2022
Closes
Jul 29, 2022
Ref
3057
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.

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 200 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.

CLINICAL SERVICES OVERSIGHT & COMPLIANCE SR. MANAGER

Work Location: Work from home 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 manage foundational and strategic relationship and regulatory oversight accountabilities that support all aspects of Clinical Services (CLS). Serve as a key member of the department and oversight efforts designed to strengthen a culture that promotes collaboration and regulatory readiness. This position will assist with setting priorities for SNP care coordination programs, including, but not limited to, process improvement strategies, organizational goals, regulatory guidance and data. Interpret and apply NCQA, state and federal regulatory mandates to support operational assessments, regulatory readiness and accreditation. You will oversee the implementation of these priorities to ensure contractual, and regulatory requirements are disseminated and understood by all stakeholders. You will also maintain relationships with delegated entities to assist in positive collaboration and open communication. In addition, you will be responsible for the program management of UCare's SNP programs, which will include: coordination and administration of a broad scope of CLS program activities, projects and initiatives, including practice management, delegate oversight, enrollment, preadmission screening, clinical liaison activities, and unable to reach and refusal activities.

• Partner with the members of the CLS Leadership Team to design and implement compliance infrastructure, including processes and tools for administration of the compliance program. May include helping to ensure the proper design and implementation of internal controls and operating policies and procedures.

• Apply knowledge of State, Federal, and other regulating bodies to the analysis of internal and delegated practice standards as well as external providers for practice performance feedback.

• Support the oversight of regulatory reporting for SNP products: Complete the MOC Evaluation annually, work with Compliance on annual DHS reporting, work with the Director on writing and submitting the MOC to CMS. Prepare and submit regulatory findings to stakeholders.

• Oversee the Care Coordination Grids. Partner with the auditors and clinical liaisons to update the language while providing sound, regulatory reasoning for updates that can be explained and implemented in a timely way, including allowing time for training to occur, and for supportive documentation to be publicly posted for delegates to access.

• Understand the care coordination processes within UCare and delegated entities in order to oversee and guide their ability to comply with contractual obligations.

• Oversee the development and implementation of auditing tools and strategies to fully analyze the ability to achieve optimal compliance with regulatory standards and meet contractual obligations.

• Oversee the coordination and implementation of delegate and internal audits, including interrater reliability audits. Oversee implementation of project plans, statement of work, and/or process flow related to different projects, and be able to prepare results analysis.

• Oversee completion of corrective action plans and other strategies to monitor the progress of each delegated entity on an ongoing basis. Escalate repeat audit findings, for action. Present findings as directed to delegated entities, Clinical Services, Mental Health & Substance User Services (MH & SUDS), Provider Relations and Contracting, and other UCare staff as appropriate.

• Oversee the completion of pre-delegation assessments, as necessary, to assure the entity has the capacity and capability to perform delegated functions. Responsibility for the preparation of written reports of assessments and communicate results to leaders and delegated entities.

• Participate in audits conducted by UCare's regulators as directed, including identification of universe and gathering of records, file preparation, and provision of information to auditors as requested.

• Coordinate and facilitate meetings with internal and external entities to disseminate information, clarify processes, escalate compliance risk, and ensure corrective action as needed.

• Develop and maintain positive relationships with internal and external entities, in order to increase cooperation and compliance with regulatory requirements.

• Oversight of the clinical liaison roles, and their interface with delegates and other key care coordination entities. Facilitation of effective partnerships and innovative strategies to facilitate excellent care to members.

• Oversight of the Delegation Oversight Auditors, and well as the MSHO/MSC+ Refusal and Unable to Reach care coordinators and engagement specialist, enrollment and preadmission screening roles.

• Other projects and duties as assigned.

Education

Social Worker or RN with requisite experience. Current and unrestricted license in Minnesota required.

Required Experience

Six years of health care, regulatory experience in the health care industry. Experience working with and interpreting state and federally funded program benefits, including Medicare and Medicaid is required. Experience with health care-related regulatory compliance, auditing, or surveying. NCQA experience.

Preferred Experience

Experience with application of NCQA Federal and state regulatory standards. Knowledge of provider contracting strategies is highly desirable.

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: 06/29/2022