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This position is responsible to translate UCare's business requirements into functional requirements in order to configure AMISYS to support benefit administration, authorization requirements and claims adjudication. Analyze new business plans and changes to existing business plans in order to establish the appropriate benefit structure needed. Works with other departments to ensure smooth impleme
Full Time
Posted 3 days ago
The Utilization Review Specialist's primary responsibilities are to evaluate member specific clinical information against objective, standardized criteria to determine medical necessity, appropriateness and efficiency of specific services the organization has targeted for prior authorization. Specific duties and responsibilities include Complete the continuum of utilization review processes withi
Full Time
Posted 5 days ago
UCare - 
Minneapolis, MN
This position is responsible for to create and maintain technical requirements and system design of EDI transaction solutions that follow established software development standards and policies. Firm understanding of ANSII ASC X12 file standards with emphasis on the healthcare related 837P, 837I, 835, and 834 transaction sets. Responsible for collaborating with EDI Operations Analyst, software eng
Full Time / Bachelor's Degree Required
Posted 5 days ago
UCare - 
Minneapolis, MN
This position is responsible to investigate and primary source verify the credentialing and re credentialing applications in accordance to NCQA, CMS and MDH Standards for all contracted providers. Provide verbal and written communication to contracted providers to obtain compliant documents and approval dates. Prioritize and organize work in order to meet regulatory requirements. Specific duties a
Full Time / High School or Equivalent Required
Posted 5 days ago
This position is responsible to design, build and expand the company's utilization of BizTalk with a focus on Service Oriented Architecture (SOA). This position will support the integration and development efforts for creating SOA applications to support consumerism and the Health Care Exchange. Ensure best practice for Enterprise Application Integration patterns are implemented. Analyze, design,
Full Time / Bachelor's Degree Required
Posted 7 days ago
UCare - 
Minneapolis, MN
As part of the digital web service team, this position is responsible to support web, SharePoint, CRM, mobile and other digital initiatives in a mission focused organization, this position is responsible to design, develop, implement, test and analyze software applications in an Agile environment. This includes researching, designing, documenting, and modifying software specifications throughout t
Full Time
Posted 7 days ago
This position is responsible to collaborate with internal UCare staff to generate, manage and organize the ongoing maintenance of provider contracts and duties associated with provider contracting. Coordinate the production and maintenance of UCare provider contracts and related compliance and business continuity functions. Provide project management support for department Assistant Directors, Man
Full Time
Posted 10 days ago
This position is responsible to coordinate material projects from start to finish. Ensure production of materials follow UCare processes for quality standards, approvals, and distribution. Confirm production schedules align with regulatory and UCare timeframes. Provide routine reporting of project status. Consult with internal stakeholders for printing and mailing needs on an ongoing basis. Ensur
Full Time / Bachelor's Degree Required
Posted 10 days ago
UCare - 
Minneapolis, MN
This position is responsible to perform monthly accounting activities; including journal entries, account reconciliations, and administrative expense analysis. Responsible for internal monthly financial reporting packages owned by the Accounting Department. Prepare regulatory filings and reporting packages for areas of responsibility. Complete the annual 990 Return. Assist in the budget process. S
Full Time / Bachelor's Degree Required
Posted 17 days ago
This position is responsible to develop and execute required member and prospect communications that meet business and organizational goals across health insurance products. Also responsible for technical writing, editing and quality assurance on regulatory agency model materials and other important member and prospect resources enhancing understanding of health care benefits. In addition, assist
Full Time / Bachelor's Degree Required
Posted 19 days ago
This position is responsible to run analytics for Customer Service contact center operations; collaborate with forecasting and staffing analysts to identify trends, operational efficiency, and productivity. Identify, analyze and plan for volume drivers and system outages to plan for optimal performance. Develop reports and analyze data from multiple systems to identify and address root cause of ca
Full Time / Bachelor's Degree Required
Posted 23 days ago
This position is responsible for the design, development, implementation, evaluation and reporting of one or more evidence based health improvement programs as they relate to the UCare strategic and annual quality plan. Accountability for leading teams, coordinating and collaborating with internal and external stakeholders, meeting project objectives and reporting to regulatory entities and leader
Full Time / Bachelor's Degree Required
Posted 26 days ago
This position is responsible to manage the Pricing Team. Oversee the analysis, design, implementation and contribute to maintenance of pricing configuration and third party pricing tools. Identify, evaluate and implement processes to improve efficiency, effectiveness and quality of pricing configuration. Ensure pricing configuration and department operations adhere to state and federal guidelines.
Full Time / Bachelor's Degree Required
Posted 26 days ago
UCare - 
Minneapolis, MN
This position is responsible to provide telephonic health coaching, management and education to members living with chronic conditions. This position also assists in efforts to improve HEDIS rates, improve health outcomes, support the CMS Chronic Condition Improvement Program, NCQA accreditation and CMS Stars initiatives. Specific duties and responsibilities include Provide individual telephonic h
Full Time / Bachelor's Degree Required
Posted 26 days ago
This position is responsible to support UCare's efforts in delivering an excellent provider experience by effectively resolving payment and service issues in a timely manner. Use critical thinking skills and claims payment knowledge to conduct root cause analysis when driving to resolve issues. Support key provider relationships by collaborating with operations staff within key provider organizati
Full Time / Bachelor's Degree Required
Posted 28 days ago
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