Hennepin County envisions an organization where our commitment to diversity is fundamental in providing excellent service to our community.
Hennepin County Diversity Policy
The mission of Metropolitan Health Plan (MHP) is: Integrating health care and service to enhance the health and well being of our members and the community. Be a leader in partnering with our members and communities to improve health.
MHP is currently looking for two Medical Services Coordinators (RNs) who will be responsible for reviewing requests for services by providers and/or members, making coverage determinations and evaluating for medical necessity; case management; utilization management, and program management.
Our offices are located in the Grain Exchange Building in Downtown Minneapolis, accessible by public transportation and light rail.
The primary duties and responsibilities of this position include: Coordinate and evaluate managed care benefit areas, i.e., inpatient utilization management, behavioral health, ambulatory utilization, and children's health.
Review member requests, apply existing criteria, determine appropriateness of services, and authorize or deny requests based on members' needs and/or their meeting eligible criteria.
Case management including: communicate care coordination information and utilization data to providers interacting with members; complete health risk assessments; develop care plans; assist members with accessing and coordinating care; manage transitions in care; and recognize member health education opportunities.
Manage and oversee member utilization, report/refer quality concerns, evaluate effectiveness and determine outcomes of provider service interventions.
Monitor programs to ensure compliance with managed care objectives by identifying problems, performing studies, implementing solutions, reporting results and evaluating outcomes.
Develop and recommend policies and procedures related to the managed care program area.
Represent the managed care concept and philosophy to outside committees, organizations, regulatory agencies, providers, hospitals and community organizations.
Participate in special projects or committees.
Serve as a resource person to other MHP staff, providers and members in the area of clinical specialization. Best Qualified Candidates will have: A valid license as a Registered Nurse in the State of Minnesota.
At least one year of clinical experience.
Experience authorizing services in a managed care environment.
Case management experience.
Ability to demonstrate the employee competencies.
Applications will be forwarded to the hiring supervisor on an on-going basis. Posting will remain open until filled.
Invitations to interview will be based upon an assessment of education and experience. A background check will be completed post interview.
If you need assistance or a reasonable accommodation to actively participate in the employment process, please email us at HR.ServiceCenter@co.hennepin.mn.us or call us at 612.348.2163.
Hennepin County provides equal access to employment, programs and services without regard to race, color, creed, religion, age, sex (except when sex is a Bona Fide Occupational Qualification), disability, marital status, sexual orientation, public assistance or national origin. If you believe you have been discriminated against, contact the Human Resources Department, A-400 Government Center, Minneapolis, MN 55487, 612-348-2163.
Current open positions may be viewed at www.hennepin.jobs
Hennepin County - 2 years ago