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Managed Care/Group Health Implementation Manager in Jacksonville, FL at One Call Care Management

Date Posted: 3/5/2018

Job Snapshot

Job Description

Managed Care/Group Health Implementation Manager

The Manager of Group Health/Managed Care Implementation is a central role that interfaces with customers to handle a variety of pre and post-implementation functions. The position is an important link to ensure Group Health/Managed Care customer requirements are handled and met in an efficient and professional manner.

Key Skills

Excellent organizational skills are required, as an important part of the job will be developing timelines, coordinating tasks, and staying aware of all aspects of assigned projects. Communication skills need to be at a high level, as the role involves communicating with customers and OCCM team members on a regular basis. Troubleshooting and problem resolution are required skills. The manager is responsible for monitoring program metrics to detect potential issues and recommend solutions, especially when issues threaten to negatively impact client expectations. Interpersonal skills are critical. The ability to establish and maintain effective working relationships with all levels of management (internally/externally), employees, clients and vendors, is fundamental to this role. The type of person that would embrace this position is friendly, professional, and secure in an ever-changing work environment that is typical in a customer service setting. Other attributes that the ideal candidate will encompass:

•A good understanding of OCCM’s diagnostic business
•Positive attitude to please customers
•Able to clearly articulate messages to a variety of audiences
•Able to establish and maintain strong relationships
•Time management in fast paced environment
•Organizational skills to maximize productivity
•Adapts to customer situation and different personalities
•Work is accurate and with eye for detail
•Always seeks to improve our customers experience
•Works independently but collaborates effectively
•Ability to solve complex issues that are in the best interest of the customer and the company
•Positively manage stress and foster mutual respect



Manage the implementation of all TPAs, carriers and partner companies such as cost containment, managed care, employer groups, and provider network partners. Communicate effectively with customers and OCCM staff in the execution of project management deliverables. Document workflows and monitor outcomes to ensure compliance internally.

•Customer introduction and deliverables communicated
•Internal stakeholders within OCCM notified
•Project management plan including workflows developed and organizationally shared
•ID card and referral source review
•Information obtained and customer set-up in system for service delivery, pricing, and administrative fee
•Interface enabling and testing: eligibility/benefit verification, clearinghouse, claims, network, and utilization mgt
•Monitor service to ensure customer expectations are met and/or make changes to internal flows or joint workflows as necessary
•Identify areas of improvement, in conjunction with functional unit leadership, to make needed process changes
•Validate existing customer renewals or new adds monthly and communicate to scheduling team


Manage the reporting needs of all TPAs, carriers and partner companies such as cost containment, managed care, employer groups, and provider network partners.

•Responsible for production, quality assurance and distribution of monthly and/or quarterly cost savings and utilization customer reports (external)
•Responsible for production, quality assurance and distribution of customized/ad hoc reports when requested by customers (external)
•Work with IT to create reporting efficiencies and value-added reports for the customers when feasible (internal)
•Maintain, update and distribute monthly customer implementation report (internal)
•Maintain, update and distribute monthly customer referrals and schedules report (internal)
•Verify quarterly producer overrides

Problem Resolution

Direct the customer complaint management and response process.

•Communicate customer issues immediately to appropriate departments within OCCM
•Ensure complaints are logged in or other database
•Identify trends in complaints
•Work with Provider Relations, Finance, Customer Service, Service Operations and other areas to resolve process issues causing complaints
•Keep Sales and Management informed of complaints, trends and resolutions

Service Metrics

Monitor the overall service delivery process internally.

•Review scheduling success rate and identify feasibility and means of improving this ratio
•Assess scheduling TAT and ensure it meets customer needs/expectations
•Evaluate claim submission TAT including underlying components of provider HCFA collections, HCFA EDI submission and collection of payer and member responsibilities
•Work effectively with Service Operations and Finance to put in place optimal flows to support these activities
•Assess the performance of payers in claim processing. Work with Finance to receive reporting and jointly review to identify areas of improvement. Work with payers when feasible to improve processing quality or timeliness

Program Management

•Review provider network needs/requests for Group Health customers. Communicate contracting/price needs to Network Development and monitor progress
•Partner with IT, Service Operations, Finance and Network Development on all Phoenix enhancements related to Group Health including the prioritization of items, design and review of test results
•Manage annual and ongoing strategic initiatives supporting Group Health as agreed upon by management

Physical/Emotional Demands and Work Environments

•For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear
•For roles located in the field; this job is primarily active; the employee is regularly mobile and must be able to utilize transportation (such as driving), sit, use hands and fingers, speak, and hear
•The employee is occasionally required to stand, walk, and lift objects (up to 10lbs weight; up to 4 ft. height)
•Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus
•The work environment utilizes florescent lighting; noise level is moderate
•The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload
•Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position
•Please be advised the job description is subject to change at any time