Job Information
UMPhysicians MSHO Managed Care RN Manager in Minneapolis, Minnesota
University of Minnesota Physicians (M Physicians) is a non-profit organization seeking driven individuals in both clinical and non-clinical areas to help transform health and medicine. Headquartered in Minneapolis, our organization employs more than 1,200 physicians, 300 advanced practice providers and 2,200 health professionals and staff throughout Minnesota and beyond. Join us on a mission to advance medicine. Why M Physicians? Regardless of role, we recognize that every member of our team is vital! The MSHO Managed Care Manager manages the MSHO Program and oversees the managed care providers and staff, ensuring that all staff remain compliant with policies and mandates, and ensures proper communication of MSHO program. Leads and provides geriatric case management and coordination of care for defined enrollees within designated managed care organizations. MSHO Managed Care Manager, RN - Overview Key responsibilities include but are not limited to: Manages and operates MSHO program strategically for the growth and success of the program, employees and system partners. Utilizes knowledge of metro market, healthcare systems, trends and potential or actual changes that may affect program. Ensures program operates within Medicare, Medical Assistance and Federal Waiver programs rules and guidelines. Responsible for oversight of growth in enrollment numbers within each contract plan. Provides supervision and direction to MSHO staff. Manages staff expenses to budget FTE expense. Responsible for adaptation of staff and compliance process related to specialty programs within established contracts i.e. Stars Measures, medication management etc. Responsible for all MCO, DHS, CMS, HEDIS, TOC audits and audit outcomes. Continually assesses and improves the performance of care and services provided by the MSHO dept. Develops and maintains Policies and Procedures for program. Maintains positive relationships with health plans and providers. Participates with community partners (MCO, DHS) in trainings, certifications, and value enhancement measures for successful outcomes. Acts as resource/liaison to clinic staff, clients, payor companies and government agencies regarding administration of contract provisions and regulations. Manages or tracks case management data to show performance in product measures. Work with contracting department and finance to negotiate contract terms and appropriate reimbursement rates, review for accuracy of payments and develop utilization goals. Participates in Quality Management projects and PIP's with UMP, DHS, MCO's. Is available to give clinical supervision and direction to staff on a day to day basis. May carry small caseload to remain current with time management and work demands of care managers following all the mandates, criteria and requirements of the MSHO Care Manager position Minimum Qualifications: Licensed RN in Minnesota. BLS. BSN. 7 years of nursing experience 3 years of Home Care or Case Management experience with extensive knowledge of Home and Community Based Services 1-2 years of geriatric case management Supervisory experience Home internet for laptop Transportation for home visits Location: Remote with expectation to drive for home visits Hours: Full Time Benefits: This is a fully benefit eligible position: Competitive wages, Healthcare (including vision & dental), 401K, parking & tuition assistance and more! M Physicians offers competitive salary and excellent benefits and provides you with the opportunity to enhance your career in the exciting field of health care through rewarding and challenging assignments and the opportunities for advancement. We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, sex, gender, gender expression, sexual orientation, age, marital status, veteran status, or disability status. We will ensure that individuals with disabilities are provided reasonable accommoda ion to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. UMPhysicians is an Equal Opportunity/Affirmative Action/Military Friendly employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex, national origin, sexual orientation, age, marital status, status with regard to public assistance, disability, or status as a protected veteran.