Clinical Services Regulatory Materials Specialist
7 days left
- Employer
- UCare
- Location
- Minneapolis, Minnesota
- Posted
- Feb 14, 2023
- Closes
- Apr 07, 2023
- Ref
- 3387
- 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 REGULATORY MATERIALS SPECIALIST
Work Location: Work from Home
Position Description
This position is responsible for providing support and structure to the Clinical Services (CLS) Department as it relates to interpretation of legislation, policy and regulatory requirements that inform how internal stakeholders conduct day to day operations. Responsible for departmental policy and procedures that support regulatory guidance. Support Clinical Services in developing content and responding to requests for new business (requests for proposals). This position requires strong written communication skills, project coordination techniques and a thorough knowledge and understanding of regulatory and accreditation standards.
• Monitor, analyze and interpret regulatory and informational guidance received from state regulatory, federal regulatory and accreditation entities to support internal policies and procedures.
• Provide updates to Subject Matter Experts related to how regulatory guidance might impact Clinical Services current policies and procedures and monitor for successfully integration of those changes.
• Collaborate across Clinical Services and Health Services to ensure alignment with regulatory guidance and the interpretation of how to operationalize/implement.
• Support, track and manage required regulatory departmental updates to ensure audit and accreditation readiness as it related to policies and procedures.
• Coordinate, manage and update Clinical Services Compliance360 (C360) Inbox and Compliance portal with support from CLS Leaders.
• Develop concise, complete, and clear proposal responses to requests for proposals and other related documents needed for new business.
• Maintain work instructions on the use of internal systems used for maintenance of policies and procedures, management of C360 reviews and request for proposal processes for Clinical Services.
• Serve as representative for any workgroups related to policy and procedures, new business, and support of requests for proposal for the department.
• Other projects and duties as assigned.
Education
Bachelor's degree in health care, a Registered Nurse with current non restricted Minnesota license, or unrestricted Minnesota license in another closely related healthcare field; demonstrated experience may be considered in lieu of degree.
Required Experience
At least three years of experience in a managed care organization, quality management program in a health care setting or related experience. At least one year of experience with regulatory review of health plan clinical materials and writing. Grant/proposal writing experience. Knowledge of State and Federal regulations, experience with national accreditation standards (NCQA).
Preferred Experience
Accreditation, auditing, and process improvement experience is preferred. Experience in managing indirect reports to obtain complex information if the most efficient manner. Experience resolving escalated issues arising from operations and requiring coordination with other departments. Understanding of project management concepts and methodologies.
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: 2/13/2023
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 REGULATORY MATERIALS SPECIALIST
Work Location: Work from Home
Position Description
This position is responsible for providing support and structure to the Clinical Services (CLS) Department as it relates to interpretation of legislation, policy and regulatory requirements that inform how internal stakeholders conduct day to day operations. Responsible for departmental policy and procedures that support regulatory guidance. Support Clinical Services in developing content and responding to requests for new business (requests for proposals). This position requires strong written communication skills, project coordination techniques and a thorough knowledge and understanding of regulatory and accreditation standards.
• Monitor, analyze and interpret regulatory and informational guidance received from state regulatory, federal regulatory and accreditation entities to support internal policies and procedures.
• Provide updates to Subject Matter Experts related to how regulatory guidance might impact Clinical Services current policies and procedures and monitor for successfully integration of those changes.
• Collaborate across Clinical Services and Health Services to ensure alignment with regulatory guidance and the interpretation of how to operationalize/implement.
• Support, track and manage required regulatory departmental updates to ensure audit and accreditation readiness as it related to policies and procedures.
• Coordinate, manage and update Clinical Services Compliance360 (C360) Inbox and Compliance portal with support from CLS Leaders.
• Develop concise, complete, and clear proposal responses to requests for proposals and other related documents needed for new business.
• Maintain work instructions on the use of internal systems used for maintenance of policies and procedures, management of C360 reviews and request for proposal processes for Clinical Services.
• Serve as representative for any workgroups related to policy and procedures, new business, and support of requests for proposal for the department.
• Other projects and duties as assigned.
Education
Bachelor's degree in health care, a Registered Nurse with current non restricted Minnesota license, or unrestricted Minnesota license in another closely related healthcare field; demonstrated experience may be considered in lieu of degree.
Required Experience
At least three years of experience in a managed care organization, quality management program in a health care setting or related experience. At least one year of experience with regulatory review of health plan clinical materials and writing. Grant/proposal writing experience. Knowledge of State and Federal regulations, experience with national accreditation standards (NCQA).
Preferred Experience
Accreditation, auditing, and process improvement experience is preferred. Experience in managing indirect reports to obtain complex information if the most efficient manner. Experience resolving escalated issues arising from operations and requiring coordination with other departments. Understanding of project management concepts and methodologies.
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: 2/13/2023
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