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This position is responsible to apply knowledge of UCare's business, products, members and operations to accurately and effectively fulfill member service requests and inquiries. Ensure adherence to policies and procedures and meet service level expectations by following established guidelines and standards. Achieve fluency in at least one core product or service line Answer, resolve, track and d
Posted Today
UCare
- Minneapolis, MN
This position is responsible to provide actuarial support to the organization and management. Perform analysis of Medicaid and Medicare data including pricing, risk adjustment and population analytics. Support the Medicare Bidding process with assumption development. Develop and enhance reporting and dashboards to track product performance and competitive environment. Draft memos and create docume
Posted Today
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
Posted 2 days ago
This position is responsible to develop, implement and maintain care system, institutional, primary care and ancillary networks; including contracting, expansion efforts, special initiatives and building and preserving strong provider relationships. Specific duties and responsibilities include Coordinate the contracting process with care system, institutional, primary care, and ancillary providers
Posted 4 days ago
This position is responsible to investigate, resolve and respond to Quality of Care complaints. Support Clinical Services and Behavioral Health with government regulatory audits and coordinate the preparation for accreditation surveys. Collaborate across departments, with consultants, and develop strong relationships with all stakeholders. Responsibilities may also include serving as the NCQA busi
Posted 6 days ago
This position is responsible to investigate and primary source verify the credentialing and recredentialing 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 an
Posted 6 days ago
This position is responsible to implement, coordinate and evaluate the delegated credentialing process including; communication with delegated contacts, conducting annual audits, data entry of delegate profiles, and monthly monitoring assuring delegated activities meet all regulatory and accrediatation requirements based on legislative mandates and company strategic direction. Specific duties and
Posted 6 days ago
This position is responsible to coordinate services across the continuum of health care to meet the health and social service needs of identified members. Collaborate with treatment providers, county and community agencies to identify and coordinate provision of health care services for UCare members. Specific duties and responsibilities include Provide telephonic case management. Understand and
Posted 6 days ago
UCare
- Minneapolis, MN
This position is responsible to support to the UCare organization via phone, remote, and onsite support. Provide real time application or hardware support to eliminate or avoid business impact. Troubleshoot, diagnose and resolve incidents/problems and outages of production environments. Respond promptly to incidents and escalate when appropriate. Triage Service Management incidents and requests i
Posted 7 days ago
This position is responsible to provide administrative and project support for the individual UCare Choices Sales Team. This position is also responsible to assist with member walk in inquires related to coverage and premium concerns across all lines of business. Schedule and coordinate sales talks and seminars both on and offsite including; room reservations, refreshment orders, enter sales talk
Posted 7 days ago
Responsible for the accurate and timely processing of the Billing department functions for our UCare for Senior UCare's Medicare Risk product, Senior Select and UCare Choices/Fairview Choices UCare's Exchange product. Which includes but is not limited to member premium payment application, member refunds and member premium returns across all products. Review and entry of all EFT forms, changes and
Posted 7 days ago
This position is responsible, in partnership with the Center of Excellence for Organizational Change Management, to develop and execute a structured approach to change management. Support UCare employees, members and providers through our core solution transformation, as well as to support change management maturity development at an organizational level. Develop metrics and methods of evaluation
Posted 8 days ago
This position is responsible to create provider network reports for various regulators (DHS, CMS, and MDH). Create PCNLs (Primary Care Network Listing), Provider Directories and policies; conduct audits of provider demographic information. Collaborate with Government Programs on all regulatory audits and RFPs related to provider network, access & availability ensuring contractual requirements are
Posted 11 days ago
This position is responsible to receive and process requests for appeals and grievances from members, member representatives, providers, and regulatory bodies. Provide live telephonic access for members, providers and internal customers. Perform case set up and preparation activities for the department. Answer incoming calls promptly to assure access for members, providers and internal customers d
Posted 15 days ago
Assist with entering, updating and maintaining provider data in Amisys. Ensure provider contracts are fully integrated into the Amisys system for proper payment of claims. Respond to internal customer requests and questions, making system adjustments as needed. Assist with the completion of large scale system updates for major care system entities and delegated entities. Set up Standard & Non Sta
Posted 16 days ago
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