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Form of workABOUT 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 14 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.
COMPLEX CASE MANAGER
Work Location: Work from Home or Office for Your Day
Position Description
As a Complex Case Manager, you will be responsible for providing comprehensive and specialized case management services to individuals with complex medical conditions and multiple health care needs. You will take on the most Complex Cases, resolving challenges, and coordinating care of patients while maintaining NCQA documentation standards. You will collaborate with healthcare providers, community resources, and internal teams to ensure the delivery of cost effective, high-quality and patient focused care.
Maintain established caseload of Complex Cases, which may include patients with multiple chronic conditions, complex medical treatments, recent transitions, and specialized care needs.
Conduct thorough telephonic assessments of patients' medical, psychosocial, social determinants of health, and functional needs, considering their complex conditions.
Develop and implement individualized care plans, ensuring they are patient-centered, evidence based, and cost effective. Incorporate culturally appropriate approaches to care planning.
Participate in interdisciplinary meetings, team projects and quality improvement initiatives to promote effective case management and improvement.
Monitor patients' progress, provide education, evaluate outcomes, and adjust care plans as necessary ensuring to empower patients and families to actively participate in management of their healthcare.
Develop subject matter expertise for clinical calls and documentation within UCare's care management software. Complete user acceptance testing for documentation system as needed.
Ensure compliance with regulatory requirements (NCQA, DHS/CMS, HEDIS and STARS measurements), organizational policies and industry standards.
Attend internal and external meetings; may serve as team representative on cross departmental meetings as assigned.
Other projects and duties as assigned.
Education
Registered Nurse (BSN preferred) with an active and unrestricted Minnesota license.
Required Experience
Minimum of two years' experience in Medical/Surgical/ICU nursing, and one year care coordination/case management across the continuum of health care (hospital, clinic, nursing home, home care etc.) with primary emphasis working with chronic medical conditions.
Preferred Experience
Public Health experience. Managed care or commercial experience with NCQA Case Management certified.
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: 12/14/2023
