Manager, Medical Management Outcomes|
Location: US-NY-Rego Park, Queens
Compensation: $90K - $125K / Year
Minimum Education: Bachelors
Job Type: Full Time
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Position Purpose: Evaluate, design, develop and implement medical management initiatives to support the business needs through various clinical analysis
- Develop and analyze various clinical data and reports on medical management programs, including authorization, utilization and case/disease management
- Develop databases, set benchmarks, identify root cause and recommend improvements
- Develop, create and implement database or automation to support and eliminate manual updates to programs within medical management
Research, identify and monitor provider utilization trends and monitor providers for adherence to contract provisions.
- Report trends and refer cases for further investigation
Conduct audits and ensuring consistency with all contractual requirements
- Respond to all inquiries related to provider assignments
- Establish criteria and strategy for pilot programs and advise on guidelines and system modifications that affect claims processing and payment decisions
- Bachelorís degree in Healthcare, Business, Quantitative science or related field.
- 4+ years business or clinical data analysis. Experience with medical coding practices, groupers and reimbursement practices. Comprehensive knowledge of current medical practices covering a broad range of medical specialties especially neonates and newborns.
- Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
- Provider and claim systems (CCMS and Amisys) experience preferred. Knowledge of ICD-9, DRGís and CPT codes preferred. Database management, SQL, Crystal Reports and/or COGNOS experience preferred.
When you apply and send in your resume please also send with the answers to the client pre-screen questions for submission purposes.
1) What is your reason for job change?
2) What is your availability to interview and start?
3) What is your desired salary?
4) How many years experience in SQL do you have?
WorkStaff USA Staffing Agency, LLC
P.O Box 177
Farmingville, NY 11738