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
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.
MENTAL HEALTH & SUBSTANCE USE DISORDER SERVICES REGULATORY LEAD
Work Location: Work from home or Office for Your Day
As the Mental Health and Substance Use Disorder Services (MH & SUDS) Regulatory Specialist, you will be responsible for leading the MH & SUDS team in regulatory audits, accreditation surveys and staying regulatory ready and continuously compliant. Serve as the NCQA business owner designee as assigned at internal committees and/or work groups. Collaborate across departments and develop strong relationships with all stakeholders. This position requires strong project management skills and thorough knowledge and understanding of NCQA standards.
• Lead the coordination of the NCQA accreditation processes for MH & SUDS including; coordinate the assigning standards, monitoring and measuring progress, and ensuring evidentiary documentation is submitted within established time frames. Ensure successful preparation for file review.
• Participate and assist in regulatory reporting & audits (CMS, DHS, MDH, NCQA) including those which are applicable to specific products such as Special Needs Program (SNP), Family and Children's, Individual and Family Plans (IFP), Medicare as well as specialized and highly regulated programs such as Restricted Recipient Program (RRR).
• Update the Utilization Management (UM) program description and evaluation, including those for the BPO product.
Write and evaluate the model of care document and annual evaluation of outcome measures.
• Oversee Parity compliance, ensuring evaluation documents are up to date and coordinating with stakeholders throughout the organization on Parity related questions and regulatory submissions.
• Lead MH & SUDS mock audits for NCQA file review, annual delegate care management & delegate utilization management audits.
• Develop work plans, tracking tools, and systems to ensure survey readiness utilizing project management tools and resources.
• Maintain timely communication with leaders regarding Compliance 360 emails.
• Serve as subject matter expert in workgroups or projects as directed by the MH & SUDs Compliance & Regulatory Manager.
• Other projects and duties as assigned.
Mental Health Professional or RN with requisite experience. Current and unrestricted license in Minnesota required.
At least three years of experience in a managed care organization, quality management program in a health care setting, or other closely related experience. NCQA experience.
Experience in project management, accreditation survey preparation process, data collection, report writing, and basic data analytic skills.
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: 3/13/2023