Medicaid Care Manager Team Lead at American Cybersystems, Inc. in New York, New York

Job Description:

Innova Solutions is immediately hiring for a Medicaid Manager Team Lead


Position type: Full Time Direct Hire
Location: NYC, hybrid

As a Medicaid Manager Team Lead you will:

• Performs Utilization Management related to inpatient level of care and home care services. Additional UM may cover other areas such as appropriate use of out of network providers.


• Conducts peer to peer discussions, as applicable, and educates physicians (in-network and out-of-network) and others on current policies and medical management issues.


• Assists in new technology assessment and clinical policy review, as required, and facilitates researching the evidence-based literature.


• Performs medical necessity and appeal reviews


• Supervises retrospective review of claims to identify practice patterns that could be improved to reduce costs and improve care


• Conducts analyses to identify trends and patterns suggestive or indicative of inappropriate or excessive use of services or equipment (fraud, waste, and abuse)


• Conducts rounds with case managers as needed


• Participates in department committees (Credentials, Medical Policy, others)


• Performs other duties as needed and assigned by the Chief Medical Officer relevant to utilization management, appeals, and clinical policy processes. The Medical Director can be a fully remote position.

Minimum Qualifications

Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicine.
A minimum of three years' clinical experience
A minimum of two years' experience in a managed care setting, in particular utilization management

Licensure and/or Certification Required

• Valid and current license to practice medicine in the state of New York.


• Board Eligible/Certification

Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.
We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines. ASK ME HOW.
Thank you!
Ginny Root
Sr Technical Recruiter
612-808-6953
ginny.root@innovasolutions.com

PAY RANGE AND BENEFITS:

Pay Range*110,000-115,000 K
*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: 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

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 hr@innovasolutions.com 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 laws. Apply Now