Clinical Services Delegation Oversight Auditor - MSHO/MSC+

Minneapolis, Minnesota
Nov 16, 2022
Nov 30, 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 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.


Work Location: Work from Home. Must be within a commutable distance to attend in-person meetings as necessary.

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 evaluating the care coordination/case management (CM) processes of UCare's delegated entities. This evaluation may include comprehensive annual assessments and demonstrated ongoing oversight. Responsible for interpreting and applying state and federal regulatory mandates in performing operational assessments; acting as liaison with DHS/MDH for certain workgroups and task forces

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

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

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

• Provide training, process reviews, chart audits, and review of other data in order to gain full understanding of the CM processes of each delegated entity.

• Initiate reporting that describes delegated entities' CM processes and the results of audits conducted in accordance with contractual and regulatory requirements. Escalate audit findings, as appropriate, to leaders for follow-up action. Present findings as directed to delegated entities, Clinical Services, Provider Relations and Contracting, and other UCare staff, as appropriate.

• Participate in internal and external audits, as directed. This includes identification of members, gathering of records, file preparation, and provision of information to auditors as requested.

• Coordinate with Clinical Care Coordinator Liaisons and Compliance Department as needed to address and clarify processes, escalate compliance risks, and ensure corrective action plans are being implemented, as needed.

• Coordinate and implement delegation oversight audits and other audits as directed.

• Develop and maintain positive relationships with delegated entities and other departments within UCare, in order to ensure cooperation and compliance with regulatory requirements and CM processes. Provide ongoing support for delegated entities CM processes, including identification of educational needs, provision of basic training, references to regulatory requirements, etc.

• Prepare information for Request for Proposals (RFP) upon request.

• Serve as a Clinical Services liaison to DHS/MDH workgroups, as identified (e.g., DHS audit protocol workgroup, DHS care coordination work group, etc.).

• Lead process improvement initiatives to enhance efficiencies in auditing a significant number of delegates.

• Help train additional staff to serve as support for CM audits and monitoring.

• Other projects and duties as assigned.


Bachelor's degree in nursing, mental health, or a closely related field. Current and unrestricted RN or LSW in Minnesota.

Required Experience

Three years Case Management experience required. 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 working in managed care organizations. Experience writing, developing and implementing policies and procedures. Amisys, HealthRules, Macess/EXP, and Microsoft Office knowledge and experience.


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: 11/15/2022

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