Restricted Recipient Coordinator
UCare Minnesota
 Minneapolis, MN

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 150 Workplace for 11 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.

RESTRICTED RECIPIENT COORDINATOR

Position Description

This position is responsible to coordinate health care services for members enrolled in the Minnesota Restricted Recipient Program (MRRP) the CMS Opioid Monitoring Program (OMP) and the Exchange Restricted Member Program (ERMP). This includes coordination of health care services for members with their designated primary care clinics/providers, specialists, hospital and pharmacy according to contracts and program requirements as defined by CMS, DHS, MN statute and the UCare Individual and Family Products Member Contract, Section: “Harmful Use of Services“.

  • Collaborate with designated providers, county, and community agencies, to identify and coordinate health care services for UCare members enrolled in a restricted or monitoring program.
  • Understand and accurately interpret and apply relevant contractual requirements, policies, procedures and regulations for members enrolled the MRRP, OMP or ERMP.
  • Conduct investigation for both potential member enrollment, re-enrollment and issue appropriate MRRP, OMP or ERMP notices and appeal rights.
  • Monitor and track member compliance with program rules.
  • Collaborate with DHS and other MCO's as needed to obtain pertinent information related to previous or current restriction status, program compliance and claims data.
  • Document review activities including all member and provider communication in accordance with professional nursing/social work and established organizational standards in the clinical documentation system.
  • Review member claims for appropriate utilization and respond to claims inquiries for payment directives in Macess.
  • Maintain compliance with all regulatory rules and timelines pertaining to the MRRP, OMP or ERMP.
  • Provide case management to members that meet criteria for mental health and substance use disorder case management and are also restricted.
  • Manage the Mental Health and Substance Use Disorder Triage Line; including answering crisis calls for members who may need triage and referral to crisis resources. Completion of a crisis assessment tool, safety plan and member follow up. Identification and referral of crisis cases to care management services as appropriate.
  • Other projects and duties as assigned.

Education

RN, LP, LPCC, LMFT or LICSW; current and unrestricted Minnesota license.

Required Experience

Two years' experience in care coordination, case management, or utilization management at a managed care organization (MCO).

Preferred Experience

Previous managed care experience with restricted member programs and/or special investigation units preferred. Experience working in mental health or substance use disorder programs highly desired. Knowledge of pharmaceutical drug categories is helpful. Dually licensed LADC.

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.