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.
CCO ASSOCIATE DIRECTOR - BUSINESS INTEGRATION & DELIVERY
Work Location: Work from home or Office for Your Day
As the Configuration & Claims Operations (CCO) Associate Director - System Integration & Delivery, you will be responsible to oversee and continuously improve the Technical Teams within the CCO Department including the HealthRules Product Owner, Vendor Payment Solutions Product Owner, EDI & Technical, and Data & Tools. In addition, you will be responsible for managing and providing oversight of improving team performance and analyzing, automating, measuring and improving processes in support of UCare and CCO's Growth, Financial, Operational and Technical Strategies and Plans. As the CCO Associate Director - System Integration & Delivery, you will build and implement sustainable and scalable processes, create visibility and transparency to work, communication plans, and collaboration between your teams and stakeholder teams.
• Oversee department processes and business product ownership for EDI claims platform, claims editing and pricing systems. Including department tools, technology, and automation.
• Accountable for the business oversight of EDI vendors and trading partners Ensure compliance with regulatory requirements and industry standards.
• Oversee Optum relationship (e.g., CES, PPS, Rate Manager.) including the Optum CES and PPS AMS Teams to insure prompt, accurate claims payment.
• Manage partnerships with IT leaders to align processes and strategies to improve configuration, EDI, automation, reporting, management and enhancement of environments, data migration, and internal and external data and information sharing.
• Accountable for the development, maintenance, and continual improvement of CCO work intake processes, including prioritization, escalation and determination of analytical rigor required.
• Partner with IT to create, implement and oversee standard practices to ensuring system integration across claims adjudication, data ecosystem, claims editing, and pricing systems through cross-functional collaboration.
• Create, implement and develop processes that provide oversight of change management related to system configuration, upgrades, updates and changes for systems that reside in CCO.
• Monitor and provide oversight of teams through issue, risk, dependency, and opportunity management including ensuring root cause analysis completion, impact, and ROI analysis, etc.
• Create and maintain operating and staff support models by team, resource capacity and forecasting planning ensuring sustainability through growth and/or expansion.
• Support, analyze, and provide input in strategy for future growth and expansion.
• Partner with the portfolio programs and projects on delivery implementation, dependency and risk or issue planning, prioritization, and transition to run the business.
• Collaborate with internal stakeholders to develop strategies to improve CCO processes and procedures, resulting in cost savings, operational risk reduction, and/or member and provider experience improvements.
• Ensure transparency and communication of metrics, project status, issues, risks, and successes.
• Assist in the development and execution of department plans and actions that are integrated with other departments and support the corporate strategic plan and UCare prioritized projects and initiatives.
• Select, train, develop and evaluate staff and leaders to ensure desired performance. Establish and communicate clear performance standards.
• Participate as a member on the Minnesota AUC Operations Committee to ensure UCare's input is provided on policy and procedure changes and that UCare maintains compliance with agreed upon operating standards.
• Serve on various UCare committees and workgroups, as assigned.
• Other projects and duties as assigned.
Bachelor's degree; Master's Degree preferred. Demonstrated work experience may be considered in lieu of a degree.
Ten years of experience working in a Claims Operations role with at least five years' experience of claims platform technical knowledge, implementation and testing. Vendor relationship management experience. Knowledge of Health Plan Operations. At least seven years of experience managing and engaging staff and/or leaders.
Strategy building experience. Process improvement, project management, and/or business analysis experience. Familiar with Medicaid, Medicare, Dual and/or Commercial claim regulations.
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: 3/27/2023