Utilization Management Manager

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 16 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.

UTILIZATION MANAGEMENT MANAGER

The current hiring base salary range for this role is:

$104,966.00/year – $118,087.20/year 

UCare anticipates paying within the above-references salary range for this position. The actual base salary offer for this position will be determined by a variety of components including but not limited to work experience, education, certifications, location of the role, internal equity, and other relevant factors.

LOCATION: Minneapolis, MN (Work from Home or Office for Your Day)

Position Description

As a Utilization Management Manager, you will be responsible to oversee the daily operations of the Utilization Review team(s).  You will provide leadership, coaching, and evaluation of staff performance and development needs.  Responsible to lead hiring and staffing efforts for all UM staff.  In addition, this position will monitor authorization activities to ensure departmental, contractual, and regulatory requirements are met.  Participate in audits and support a culture of continuous process improvement and audit readiness.  Collaborate with leadership across Health Services and other UCare Departments to improve daily operations, enabling staff to better serve our members and providers. 

• Provide oversight of the Utilization Review team(s). Oversee training and onboarding of team members. Plan, organize, and manage the daily operations of the Utilization Management (UM) program.  

• Ensure UM program activities meet or exceed requirements set by regulatory agencies, including the Minnesota Department of Health, Minnesota Department of Human Services (DHS), Centers for Medicaid and Medicare Services (CMS), and the Minnesota Department of Commerce. Participate in audits as needed. 

• Assist in developing strategy for the Utilization Management program; establish performance metrics and measure UM program performance. 

• Develop and maintain policies, procedures, and performance standards for utilization review staff. Provide leadership and direction to staff including mentoring and coaching as appropriate. 

• Ensure Utilization Review Specialists adhere to organization and regulatory policies, timelines, and authorization requirements. Administer the Inter-Rater Reliability test at least annually. 

• Maintain a comprehensive knowledge of UCare products and member benefits. Understand, implement, and support the Evidence and Certificate of Coverage. 

• Represent the UM program in internal and/or external work groups and initiatives as assigned by the Utilization Management Director. 

• Support the administration of the annual Utilization Management Provider Survey. Analyze all responses and compose an executive summary of the results and present results to UM Workgroup, HSMC, QIACC and others, as requested by Utilization Management Director. 

• Oversee the identification and evaluation of initiatives responding to utilization trends and service costs. Assist with drafting the annual Utilization Management Evaluation. 

• Foster employee engagement and support the values of UCare while delivering on member and provider satisfaction. 

• Other projects and duties as assigned.