Care Management Manager - Medicare/Commercial/BPO

Minneapolis, Minnesota
Nov 18, 2022
Dec 31, 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 or Office for Your Day

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 overseeing the Medicare/Commercial/BPO care management programs. Lead and develop strategy and align activities with the medical management strategy. Develop care models in accordance with population needs, managing care management daily operations, developing and monitoring outcome program metrics, monitoring compliance with regulatory agencies, contractual obligations regarding care management duties, collaboration with community partners and delegates to ensure quality care management programming.

• Evolve and lead the Medicare/Commercial/BPO care models and care management team. Support growth and development of team skill sets, ensure operational preparedness, regulatory compliance, and individual/program performance management.

• Oversee day-to day operational support and leadership of the Medicare/Commercial/BPO Care Management Program and UM/CM functions.

• Collaborate with clinical services leaders, health services leaders, medical directors, Heath Promotion and other UCare departments to facilitate effective program operations and utilization and case management.

• Establish key external stakeholder relations with providers, community resources, county contacts, etc. to advance the reach of the programs.

• Oversee the development of organizational and system procedures and use of data to drive population needs, develop, and monitor key metrics, to include social factors impacting health, to evaluate care management processes/interventions.

• Works collaboratively with care systems and delegates, as appropriate to ensure communication, compliance, and consistency across case management programs.

• Perform continuous evaluation of key metrics and update policies/procedures for all programs. Adheres to DHS/CMS/NCQA standards to achieve the goals and business objectives of the programs.

• Lead and/or participate in work groups and committees as assigned.

• Participate in the selection and orientation of assigned staff to ensure appropriate screening, hiring, and effective selection of staff members.

• Represent UCare as an active member of Medicare/Commercial/BPO related work groups, sub-committees, interactions with regulators, and special projects. Some travel may be required.

• Prepare monthly reports of activities and identifies opportunities of improvement to increase efficiencies, productivity, and quality of work.

• Ensure that Medicare/Commercial/BPO utilization management, in alignment with organizational goals, are met.

• Other projects and duties as assigned.


Bachelor's degree in nursing or related field. Unrestricted and current RN Minnesota licensure.

Required Experience

Five years of experience in health care industry. Manager experience in both provider and managed care healthcare environments. Two years supervisory or other leadership roles.

Preferred Experience

Knowledge of payer and provider utilization and case management.

Community-based experience in Medicare operations. Experience with NCQA complex case management standards. Master's degree. Certified Case Manager.


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: 11/17/2022

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