UCare

Clinical Services Lead Oversight Auditor

7 days left

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Nov 22, 2022
Closes
Dec 10, 2022
Ref
3259
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.

CLINICAL SERVICES LEAD OVERSIGHT AUDITOR

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 providing day-to-day work direction for the Clinical Services Oversight Auditor Team and acting as a liaison to the Compliance Care Team Supervisor and Compliance Senior Manager. Responsible for auditor training on tools and job aids, interpreting state and federal regulatory mandates, and ensuring their application to audits and quality reviews are correct. Evaluate care coordination processes of UCare's delegated entities with comprehensive annual assessments and demonstrated ongoing oversight. Act as a liaison with DHS/MDH for certain workgroups and task forces.

• Create training material for new and existing auditors. Orient auditors on audit templates, tools, job aids, resources, and overall responsibilities. Develop and maintain audit tools and templates for all applicable UCare programs. Tools will analyze the ability of each delegated entity to achieve optimal compliance with regulatory standards and to meet contractual obligations.

• Facilitate Clinical Services (CLS) auditor team meetings, as well as joint Mental Health and Substance Use Disorder Services (MH & SUDS) auditor meetings in partnership with Supervisors and Managers, as applicable.

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

• Report findings, analyses, and areas of improvement to Compliance Oversight Manager and Team Supervisor. Escalate audit findings, as appropriate, to leaders for follow-up action. Present findings as directed to delegated entities, Clinical Services, Compliance, Provider Relations and Contracting, and other UCare staff, as appropriate. Track metrics and report to supervisor, including highest compliance concerns and effective interventions.

• Lead and participate in internal and external audits and quality reviews, including Transitions of Care requirements and Care Coordination Grid Requirements. This includes identification of members, gathering of records, file preparation, and provision of information to auditors as requested.

• Facilitate inter-rater reliability tasks between auditors and of audit tools. This includes determining number of audits per project and analyzing results.

• Develop and maintain positive relationships with delegated entities and other departments within UCare, 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.

• Oversee the MSC+/MSHO Care Coordination Requirements Grids. Provide 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 posted for delegates to access post leadership approval of information sharing. Track feedback and incorporate into future publications. Collaborate with the MSS Clinical Liaisons to present comparable grids to SNBC and MSC+/MSHO delegates.

• Collaborate with Clinical Care System Liaisons for united efforts with delegate entities on Requirements Grids, audit findings, CC online resources, and trainings.

• Prepare information for Request for Proposals (RFP), as assigned.

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

• Support the training of additional staff to serve as support for CM audits and monitoring.

• Other projects and duties as assigned.

Education

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

Required Experience

Five years Case Management or Pre Coordination 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

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: 11/21/2022

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