UM Medical Management & Implementation Manager

Leading Health System

Job #587534 Location: New York City Salary: Competitive

UM Medical Management & Implementation Manager – Hybrid Position in NYC

We are seeking a talented candidate with experience in benefits configuration, regulatory system changes, and strategic initiatives related to medical management within a health plan. Should have strong operational experience similar to a project manager within a health plan environment.

About the Organization

This is a leading managed care organization serving a large metropolitan area. With hundreds of thousands of members and a robust team of employees, we are dedicated to providing high-quality healthcare services through a comprehensive range of products. Our extensive provider network includes thousands of primary care providers, specialists, and participating clinics. For decades, we have been committed to fostering strong relationships with members and providers, helping individuals access the care they need. Employees benefit from competitive retirement and pension plans, along with a dynamic and collaborative work environment.

Job Overview

  • Under the supervision of senior clinical leadership and in collaboration with the SWAT Director of Implementation, the UM Medical Management & Implementation Manager will be a key member of a cross-functional team ensuring the successful execution of regulatory system changes and strategic initiatives related to medical management.

This role involves:

  • Overseeing policy and workflow updates.
  • Managing implementation timelines.
  • Ensuring system changes support accurate claims processing, benefits administration, utilization management, and care coordination.
  • Conducting post-production audits to validate implementation success.
  • Serve as a subject matter expert, ensuring compliance, effective interdepartmental collaboration, and seamless operational transitions.

Key Responsibilities

Act as a primary stakeholder in the SWAT team for benefit configuration, provider data management, and regulatory compliance. Ensure timely and accurate implementation of regulatory changes, including full-cycle project oversight and testing for medical management. Develop staff communication materials related to project impacts and collaborate with the Training & Development team on necessary training. Track project progress using designated systems and provide updates to leadership. Collaborate with regulatory and compliance teams on product readiness reviews and ongoing oversight activities. Work cross-functionally to enhance performance and operational efficiencies. Provide expertise in benefit design, care management, utilization management, and regulatory implementations. Analyze and oversee complex benefit and system configurations to ensure accuracy. Identify risks and escalate gaps to leadership and compliance teams as needed. Maintain compliance with federal and state regulations for medical and behavioral health services.

Qualifications

  • Experience in benefits configuration and medical management operations within a health plan.
  • Strong project management skills with the ability to navigate cross-functional collaboration.
  • Knowledge of regulatory requirements and healthcare compliance.
  • Ability to analyze complex healthcare data and implement system improvements.
  • This role requires a proactive, detail-oriented professional with a strategic mindset to support seamless healthcare operations and regulatory compliance.