Medical Management Implementation
Company: Innova
Location: New York
Posted on: March 1, 2025
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Job Description:
Innova Solutions is hiring a Medical Management Implementation
Manager for a client in NYC.
If you are interested in applying for this job, please make sure
you meet the following requirements as listed below.
The Medical Management Implementation Manager is part of a
cross-functional/department SWAT team that ensures regulatory
required system changes are implemented including post-production
audits. The Medical Management Implementation Manager will also be
responsible for implementing any company strategic initiatives that
involve medical management scope of work. This position is
responsible for assuring all impacted Medical Management policies,
procedures and staff workflows are revised including communication
of implementation status and resolution of barriers to medical
management leadership. The Medical Management Implementation
Manager must provide subject matter input that assures system
changes result in accurate impacted claims, benefits, utilization
and care management requirements, and member handbook and provider
guidance. The SWAT team ensures the requirements are understood
across impacted departments and new enhanced processes are
developed. Lastly, this position will be responsible for the
medical management oversight of the implementations from start to
completion including comprehensive testing.
General Notes - MUST have a strong background in Managed Care.
Needs to understand how benefits work an dhow regulated they can
be. Benefits comes out from the stat, needs to process it and
understand how to bring this into operations.
Bachelor's Degree is Required
2 days Onsite with Thursday Required
Scope of Role & ResponsibilitiesKey stakeholder in SWAT team for
behavioral health, pharmacy, and physical health benefit
configuration, provider data, internal and external communications,
accurate claims payment, and assuring positive impact on clinical,
quality, and operational excellence.
Responsible to ensure accuracy and timeliness of the full project
cycle of regulatory implementations from beginning through
completion, including comprehensive testing for medical
management.
Responsible for developing medical management staff communications
on project/implementation impact and provide input to the Training
& Development team for any required staff training.
Responsible for understanding implementation requirements and
ensuring team is actively tracking the project to completion
through QuickBase.
Liaise with the Regulatory and Compliance department as it relates
to product readiness reviews, implementation, and ongoing oversight
of activities.
Collaborate with departments across the Company organization to
continually understand and optimize performance.
Serve as subject matter expert in all benefit, behavioral health
rate, care management and utilization management functional areas
in Regulatory implementations.
Knowledge and analysis of complex Product benefit and system
configurations.
Provide oversight on benefit implementations ensuring proper
configuration.
Provide input to required changes and impact to implementation to
Company vendors.
Provide behavioral health, pharmacy and physical health subject
matter expertise to the SWAT team through collaboration with
various medical management leadership input.
Monitor project progress at each stage of the process. Identify
risks and escalate gaps to Medical Management leadership, SWAT
Director of Implementation, and Regulatory and Compliance
teams.
Ensures compliance with Federal and State regulations as they
relate to behavioral health and physical health.
Required Education, Training & Professional ExperienceBachelor's
degree required
Minimum seven (7) years of experience working in Health Care and
experience with NY State sponsored programs and CMS regulations in
managed care.
Knowledge of medical, behavioral health and pharmacy benefit
structures for various lines of business.
Knowledge of utilization and care management workflows.
Project Management skills preferred.
Working knowledge of Product Department, implementations, system
transformation and operational aspects of health care.
Skills in Microsoft Excel, PowerPoint, and Word are required
PAY RANGE AND BENEFITS:
Pay Range: $100-120K. This also includes bonus/benefits
Pay range offered to a successful candidate will be based on
several factors, including the candidate's education, work
experience, work location, specific job duties, certifications,
etc.
Benefits: This is a Direct Hire position.
ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in
Atlanta, Georgia, Innova Solutions employs approximately 50,000
professionals worldwide and reports an annual revenue approaching
$3 Billion. Through our global delivery centers across North
America, Asia, and Europe, we deliver strategic technology and
business transformation solutions to our clients, enabling them to
operate as leaders within their fields.
Website: https://www.innovasolutions.com/
Innova Solutions is an Equal Opportunity Employer and prohibits any
kind of unlawful discrimination and harassment. Innova Solutions is
committed to the principle of equal employment opportunity for all
employees and to providing employees with a work environment free
of discrimination and harassment on the basis of race, color,
religion or belief, national origin, citizenship, social or ethnic
origin, sex, age, physical or mental disability, veteran status,
marital status, domestic partner status, sexual orientation, or any
other status protected by the statutes, rules, and regulations in
the locations where it operates. If you are an individual with a
disability and need a reasonable accommodation to assist with your
job search or application for employment, please contact us at or
(770) 493-5588. Please indicate the specifics of the assistance
needed. Innova Solutions encourages all interested and qualified
candidates to apply for employment opportunities. Innova Solutions
(HireGenics/Volt) does not discriminate against applicants based on
citizenship status, immigration status, or national origin, in
accordance with 8 U.S.C. - 1324b.
The company will consider for employment qualified applicants with
arrest and conviction records in a manner that complies with the
San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance
Initiative for Hiring Ordinance, and other applicable.
Benefits: Innova Solutions offers benefits( based on eligibility)
that include the following: Medical & pharmacy coverage,
Dental/vision insurance, 401(k), Health saving account (HSA) and
Flexible spending account (FSA), Life Insurance, Pet Insurance,
Short term and Long term Disability, Accident & Critical illness
coverage, Pre-paid legal & ID theft protection, Sick time, and
other types of paid leaves (as required by law), Employee
Assistance Program (EAP).
ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in
Atlanta, Georgia, Innova Solutions employs approximately 50,000
professionals worldwide and reports an annual revenue approaching
$3 Billion. Through our global delivery centers across North
America, Asia, and Europe, we deliver strategic technology and
business transformation solutions to our clients, enabling them to
operate as leaders within their fields.
Recent Recognitions:
One of Largest IT Consulting Staffing firms in the USA - Recognized
as #4 by Staffing Industry Analysts (SIA 2022)
ClearlyRated - Client Diamond Award Winner (2020)
One of the Largest Certified MBE Companies in the NMSDC Network
(2022)
Advanced Tier Services partner with AWS and Gold with MS
Innova Solutions is an Equal Opportunity Employer and prohibits any
kind of unlawful discrimination and harassment. Innova Solutions is
committed to the principle of equal employment opportunity for all
employees and to providing employees with a work environment free
of discrimination and harassment on the basis of race, color,
religion or belief, national origin, citizenship, social or ethnic
origin, sex, age, physical or mental disability, veteran status,
marital status, domestic partner status, sexual orientation, or any
other status protected by the statutes, rules, and regulations in
the locations where it operates. If you are an individual with a
disability and need a reasonable accommodation to assist with your
job search or application for employment, please call (770)
493-5588. Please indicate the specifics of the assistance needed.
Innova Solutions encourages all interested and qualified candidates
to apply for employment opportunities. Innova Solutions
(HireGenics/Volt) does not discriminate against applicants based on
citizenship status, immigration status, or national origin, in
accordance with 8 U.S.C. - 1324b.
The company will consider for employment qualified applicants with
arrest and conviction records in a manner that complies with the
San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance
Initiative for Hiring Ordinance, and other applicable laws.
Keywords: Innova, New York , Medical Management Implementation, Executive , New York, New York
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