Qureos Mentor

Medica Services Company LLC

<div>Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration &mdash; because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Workforce Management Analyst is responsible for developing long‑term forecasts and capacity plans to support call center operations. This role emphasizes the creation of staffing models and the production of accurate, data‑driven forecasts to optimize operational performance and align resource needs with budgetary objectives. The position does not include real‑time queue management or scheduling responsibilities.

Key Accountabilities
<ul>
<li>Develop long‑term volume forecasts by analyzing historical performance trends and anticipating future business drivers</li>
<li>Build comprehensive staffing models incorporating multiple input variables to project future resource requirements</li>
<li>Create FTE forecasts aligned with operational budget targets, leveraging productivity assumptions and continuous‑improvement initiatives</li>
<li>Collaborate with Operations, Training, Quality, HR, and Finance to incorporate business changes into forecasts and staffing plans</li>
<li>Support new initiatives, product launches, and process changes by modeling operational impact</li>
<li>Reconcile forecasts, assumptions, and data inputs within workforce management systems to maintain accuracy and alignment</li>
<li>Document assumptions and provide clear business justification to support forecasting methodologies and recommendations</li>
<li>Perform additional responsibilities as assigned</li>
</ul>
Required Qualifications
<ul>
<li>Bachelor's degree or equivalent experience in related field</li>
<li>5 years of work experience beyond degree</li>
</ul>
Preferred Qualifications
<ul>
<li>Prior experience in medium- to large-scale operational call center environments</li>
<li>Demonstrated ability to create, maintain, and deliver accurate forecasts and optimized schedules that achieve service-level targets and support annual budget objectives</li>
<li>Advanced proficiency in Microsoft Excel and strong data analytics capabilities</li>
<li>Proven ability to prioritize workload, meet deadlines, and manage multiple tasks with exceptional attention to detail</li>
<li>Strong organizational, problem‑solving, and analytical skills</li>
<li>Excellent verbal and written communication skills, with the ability to engage professionally with stakeholders at all levels of management</li>
<li>Experience with Five9 and Verint preferred, experience with Avaya CMS Supervisor also acceptable</li>
<li>Experience with data visualization tools such as Qlik Sense, Tableau, or Power BI preferred</li>
</ul>
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN or Madison, WI.

The full salary grade for this position is $68,800 - $118,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $68,800 - $103,215. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica&rsquo;s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.</div>

Workforce Management Analyst III

<div>Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration &mdash; because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

Oversees contractual and regulatory requirements necessary to service Medica&rsquo;s contracts with the Department of Human Services. Includes communication of requirements with affected areas within Medica and vendors by monitoring their activities and through thorough documentation of implementation and contract adherence activities in accordance with Medica standards. Submits regulatory reports to DHS, responds to internal inquiries and DHS inquiries following Medica Regulatory Adherence team process. Performs other duties as assigned.

Key Accountabilities
<ul>
<li>Track State Medicaid Regulatory Requirements</li>
<li>Communicate regulatory changes to internal teams, track adherence to new requirements</li>
<li>Review and submit materials to State Medicaid agency</li>
<li>Conduct quality check and submit reports as assigned</li>
</ul>
Required Qualifications
<ul>
<li>Bachelor's degree or equivalent experience in related field</li>
<li>3 years of work experience beyond degree</li>
</ul>
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $56,600 - $97,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $56,600 - $84,840. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica&rsquo;s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic. 
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.</div>

Regulatory Adherence Analyst

<div>Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration &mdash; because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

A Manager, Provider Contracting is responsible for leading a team to negotiate, manage, and maintain contracts with providers to ensure financial and regulatory compliance. Key duties include developing contract strategies, overseeing contract lifecycle management, ensuring legal and regulatory compliance, and mentoring the team to achieve key performance indicators (KPIs) related to turnaround times and compliance. The role requires strong leadership to manage contract negotiations, build provider relationships, and monitor financial performance.

Key Accountabilities
<ul>
<li>Team leadership: Mentor and manage a team of contract managers, guiding them through complex negotiations and ensuring they meet performance goals and deadlines.</li>
<li>Strategic negotiation: Lead and support contract negotiations with providers to secure favorable terms that support the organization's financial and strategic objectives.</li>
<li>Contract lifecycle management: Oversee the entire contract lifecycle from initiation, creation, and negotiation to execution, monitoring, and renewal/termination.</li>
<li>Compliance and regulatory adherence: Ensure all contracts and processes comply with federal, state, and industry standards and legal requirements.</li>
<li>Financial and operational oversight: Analyze contract performance, monitor key financial metrics like reimbursement rates, and make recommendations for improvement.</li>
<li>Relationship management: Foster and maintain strategic relationships with provider partners</li>
<li>Process improvement: Develop and maintain policies, procedures, and templates for contracting. Identify opportunities for internal process improvement and implement new provider programs or payment models.</li>
<li>Cross-functional collaboration: Liaise with other departments, such as billing, legal, and operations, to ensure accurate implementation and understanding of contract terms.</li>
</ul>
Required Qualifications
<ul>
<li>Bachelor's degree in healthcare, finance, economics, or equivalent experience in related field</li>
<li>5 years of related experience beyond degree as a people leader in contract negotiations and healthcare</li>
</ul>
Skills and Abilities
<ul>
<li>Proven track record as a team leader with staff management skills</li>
<li>Excellent communication (written, verbal and presentation) skills</li>
<li>Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that&rsquo;s conveyed</li>
<li>A proven track record as a successful contract negotiator for health care services, provider or health plan</li>
<li>Flexibility and creativity in developing effective contracting terms</li>
<li>Knowledge of provider contracting components and strategies such as but not limited to risk-based contracting, financial models, operational impact and data analytics</li>
<li>Demonstrated understanding of complex financial arrangements and quality programs across health care products</li>
<li>Strong financial, analytical and problem solving skills, and understanding of legal documents</li>
<li>Strategic-thinking skills with the ability to conceptualize a wide range of scenarios and the ability to analyze each scenario to come up with the most viable option</li>
<li>An understanding and appreciation for standardizing processes to generate efficiencies and improve service levels</li>
</ul>
This position is an Office role, which requires an employee to work onsite at our Madison, WI office, on average, 3 days per week.

The full salary grade for this position is $100,300 - $172,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $100,300 - $150,465. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica&rsquo;s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.</div>

Manager, Provider Contracting (Madison, WI)

<div>Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration &mdash; because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Clinical Vendor Program Manager role is responsible for the vendor oversight and delivery of a delegated Utilization Management program. This role works closely with the Clinical Vendor Oversight Manager to ensure compliance with contractual obligations, regulatory requirements, and organizational standards. The Clinical Vendor Program Manager serves as the primary liaison between the organization and the Utilization Management vendor driving performance, quality, and affordability initiative success to meet and support Medica&rsquo;s mission, vision and desired outcomes. Performs other duties as assigned.

Key Accountabilities
<ul>
<li>Vendor Oversight and Compliance
<ul><li>Act as the main point of contact for the vendor relationship to support a delegated clinical program and affordability initiative</li>
<li>Vendor Performance &amp; Accountability:
<ul><li>Monitor vendor adherence to contractual terms, maintain service level agreement (SLA) documentation and budget management</li>
<li>Identify opportunities within the program and implement corrective action and remediation plans when necessary</li>
</ul></li><li>Partner with Clinical Regulatory Oversight Program Manager to maintain regulatory compliance and deliverables</li>
<li>Ensure timely submission of reports and deliverables as outlined in Statements of Work (SOW)</li>
</ul></li></ul><ul><li>Program Management, Collaboration &amp; Communication
<ul><li>Manage cross-functional relationships between IT and Business Partners to include but not limited to:
<ul><li>Provider Network, Internal Utilization Management, Provider Data and Eligibility Teams, Claims, Customer Service and Account Management to support program success</li>
</ul></li><li>Oversee affordability measures and outcome monitoring</li>
<li>Drive regular meetings with vendors and internal stakeholders to ensure program success</li>
<li>Facilitate complex conversations with vendors to achieve Medica's desired outcomes</li>
<li>Provide updates to leadership on vendor performance, risks, and mitigation strategies</li>
</ul>
</li></ul>Required Qualifications
<ul>
<li>Bachelor's degree or equivalent experience in related field</li>
<li>7+ years of related experience beyond degree</li>
</ul>
Skills and Abilities
<ul>
<li>Experience in vendor management, and clinical delegated vendor oversight strongly preferred</li>
<li>Computer proficiencies including Microsoft Office (Word, Excel, Access, Outlook, Visio, OneNote, etc.) and experience with others.</li>
<li>Program functions (workflow, eligibility, claims, etc.)</li>
<li>Ability to lead and be a good role model, influence change, shape and initiate work with colleagues across the organization and external (care systems, community collaborations, and vendors) to achieve department goals</li>
<li>Ability to provide leadership based on teamwork, commitment &amp; creative linkages with organizational business units, external vendors and care system representatives</li>
<li>Excellent written and verbal communication skills with all levels of the organization</li>
<li>Managing/Delegating/Measuring Work: Ability to develop appropriate objectives, accountabilities and measures. Ability to monitor and report progress; identify and address barriers</li>
<li>Quality Focus: Commitment to continuous quality improvement in all aspects of work. Skilled user of quality tools and techniques</li>
<li>Experience setting expectations and direction for delivery by the team</li>
</ul>
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $88,800 - $152,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $88,800 - $133,245. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica&rsquo;s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.</div>

Clinical Vendor Program Manager IV

Join Medica Services Company LLC and explore 4   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Medica Services Company LLC

ABOUT_COMPANY

Workforce Management Analyst III

Regulatory Adherence Analyst

Manager, Provider Contracting (Madison, WI)

Clinical Vendor Program Manager IV