UCare

Senior Delegation Auditor

7 days left

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Aug 04, 2022
Closes
Aug 25, 2022
Ref
3110
Category
Healthcare
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.

SENIOR DELEGATION AUDITOR

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

As the Senior Delegation Auditor, you will be responsible for evaluating the Utilization Management / Coverage Determination (UM/CD) and Care Coordination/Case Management (CM) processes of UCare's delegated entities and selected provider groups. This evaluation includes comprehensive annual assessments and demonstrated ongoing oversight. This work will be in support of, and at the direction of, the Delegation Audit Supervisor.

• Apply knowledge of State, Federal, and other regulating bodies' UM/CD and CM practice standards to the analysis of delegated entity performance.

• Understand the UM/CD and CM processes within UCare and delegated entities in order to assess and evaluate their ability to comply with contractual obligations.

• Work with the Delegation Audit Supervisor to develop and implement auditing tools and strategies to fully analyze the ability of each delegated entity to achieve optimal compliance with regulatory standards and meet contractual obligations.

• Conduct delegated entity oversight meetings consisting of interviews, process reviews, chart audits, and review of other data in order to gain full understanding of the UM/CD and/or CM processes of each delegated entity.

• Write detailed reports that describe delegated entities' UM/CD and CM processes and the results of audits conducted in accordance with contractual and regulatory requirements.

• Oversee the completion of Corrective Action Plans (CAPs) and other strategies to monitor the progress of each delegated entity on an ongoing basis. At the direction of the Delegation Audit Supervisor, escalate high risk (including repeat audit findings), as appropriate, to leaders for action. Present findings as directed to delegated entities, Clinical Services, Pharmacy Management, Provider Relations and Contracting, and other UCare staff as appropriate.

• Conduct pre-delegation assessments, as necessary, to assure the entity has the capacity and capability to perform delegated functions. Prepare written reports of assessments and communicate results to leaders and delegated entities.

• Participate in internal and external audits 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 delegated entities to disseminate information, clarify processes, escalate compliance risk, and ensure corrective action as needed.

• Together with the Delegation Audit Supervisor, develop and maintain positive relationships with delegated entities and other departments within UCare, in order to ensure cooperation and compliance with regulatory requirements and UM/CD and CM processes. Provide ongoing support for delegated entities related to UM/CD and CM processes, including identification of educational needs, provision of basic training, references to regulatory requirements, etc.

• Lead compliance incident investigations pertaining to UM/CD and CM, working with appropriate staff in Clinical Services, Pharmacy Management, etc. from initial report through resolution of incident.

• Other projects and duties as assigned.

Education

Bachelor's degree; demonstrated experience may be considered in lieu of degree. RN or LPN with current Minnesota license.

Required Experience

Five years case management, utilization management or coverage determination experience (or five years auditing these areas) 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.

Preferred Experience

Experience with application of NCQA and state regulatory standards to UM/CD processes. 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: 08/03/2022

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