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 12 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.
Work Location: In the office, work-at-home or hybrid (in the office 3 or more days per week)
The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.
This position is responsible to for contract oversight activities for the Centers for Medicare & Medicaid Services (CMS) contracts. Oversee regulatory and contract communications with CMS and the company’s BPO partners; communication of Medicare Advantage, Part D and Special Needs Plan (SNP) regulatory changes; and CMS applications for Medicare Advantage, Part D, and SNPs. Provide guidance to internal departments on the analysis of requirements and regulatory communications related to Medicare Supplement, Medicare Advantage plans, Part D and SNPs; provide expertise as internal departments operationalize regulatory requirements. Serve a key role in product strategy recommendations for Medicare Advantage products. Lead on certain CMS non-financial audits.
· Manage contracts with CMS for Medicare Advantage, Part D, and SNPs.
· Serve as primary liaison to CMS for program administration and regulatory oversight of Medicare Advantage, Part D, and SNPs. As necessary, advise the company’s BPO partners regarding CMS regulatory requirements.
· Oversee analysis and communication of Medicare Advantage and Part D contractual, regulatory, and policy information to internal departments. Collect and prioritize incoming regulatory and policy information, including information from CMS, the Health Plan Management System (HPMS), the Federal Register, trade associations and the state. Proactively identify impact on Medicare products, including Medicare Supplement. As determined, communicate with key departments and/or coordinate applicable response or operational implementation. Collect and analyze federal health reform regulation and policy. Communicate proposed and final rules, requirements, and policies to staff and internal committees.
· Oversee CMS new and expansion applications for Medicare Advantage, Part D, and SNPs.
· Manage CMS non-financial audits of Medicare Advantage, Part D and SNPs, including CMS program audits and data validation audits from preparation through post-audit activities. Work with internal departments to develop corrective action plans for identified issues until each Corrective Action Request is closed by CMS. Communicate progress of monitoring program and issues for resolution to the Vice President Government Relations; Associate Director Government Relations; VP Chief Compliance and Ethics Officer; and other senior staff members as needed
· Provide leadership and represent UCare at internal and external activities relating to federal government programs and new business opportunities.
· Lead development of new, and revisions to existing, department policies and procedures owned by the federal team.
· Develop and manage the federal team. Includes setting team standards and internal training schedules.
· Provide assistance to the Associate Director Government Relations and the VP Government Relations on strategic and department planning.
· Monitor critical state and federal program issues affecting the department and program administration. Monitor operational implementation of federal requirements. Work with Corporate Compliance to assess risk and auditing of federal regulations and requirements.
· Other projects and duties as assigned.
Bachelor’s degree in a related field; demonstrated experience in the health care industry may be considered in lieu of degree.
Four years related experience in a health care delivery setting (i.e., managed care organization, regulatory agency, or health insurance). Comprehensive knowledge of Medicare, including government regulations, rules and guidance. Two years supervisory experience.
1. Knowledge of Medicaid managed care.
2. Project management.
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.
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.