Data Engineer (EDI, claims)

Innova Solutions is hiring a

Medical Management Implementation Manager

for a client in NYC.

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 & Responsibilities

Key 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 Experience

Bachelor’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.