MSHO Managed Care Specialist - 1.0 FTE

As the multi-specialty group practice for the faculty of the University of Minnesota Medical School, University of Minnesota Physicians has more than 950 physicians and 1,600 health professionals, providing clinical care in over 100 specialty and sub-specialty areas. Our mission is three-fold: delivering exceptional patient care, advancing medicine through research, and training the next generation of health professionals.

Why UMPhysicians?

The Managed Care Specialist is a vital member of the UMP team ensuring that lines of communications between all aspects of the care model are functioning and thereby helping our patients receive the best care possible.

The Managed Care Specialist partners with the MSHO care managers, members, family representatives and service providers to meet members’ needs, determine appropriate programs and attain identified goals as assessed by the care-manager health risk assessment. This is a role that works across several departments and clinics and can handle and thrive in a fast pace environment while maintaining excellent customer experience.

Managed Care Specialist Overview

Key responsibilities include but are not limited to :

• Works with the MSHO care managers to meet the assessed needs of the members and attain the goals identified by the member as addressed in the member specific plan of care.
• Arranges and coordinates the provision of supports and services identified in the members’ care plan, including knowledgeable and skilled specialty services and prevention and early intervention services.
• Assists Care Managers and members to manage inpatient utilization and transitions between settings of care.
• Manages and maintains Access database.
• Maintains caseload of MCO members that care managers are unable to reach or locate and continue searches per MCO directions until location and appropriate clinic identified.
• Demonstrates ability to provide care or service adjusting approaches to reflect developmental level of population served. (as applicable)

Minimum Qualifications:

• College degree or equivalent combination of directly related education, experience and knowledge in healthcare management, Medicare, Medical Assistance and Federal waiver programs.
• 3 years’ experience working with MSHO health care systems. Knowledge of geriatric health care management and local services and programs. Knowledge of patient utilization and Transition of Care process defined by DHS and MCO’s.
• Medical terminology, ICD-9/10 Codes.
• Intermediate level knowledge of Access , Excel and Acrobat/Adobe Pro.
• Knowledge of community service organizations, agencies, programs and funding sources.
• Excellent communication and organizational skills to effectively work with service providers, team members, and clients.
• Flexible hours to meet patient and health care manager needs.
• Proven ability to negotiate fees with providers.
• Excellent problem solving and critical decision skills.

Location Description: UMPhysicians

Location: 720 Washington Ave SE, Minneapolis, MN 55414/Remote Work

Hours: 1.0 FTE

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.