Manager I, GBD Special Programs (UM) at Elevance Health

Richmond, Virginia, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Medicaid, InsuranceIndustries

Requirements

BA/BS degree and minimum of 5 years experience in a related field, including minimum of 1 year leadership/management experience (or equivalent combination of education and experience)
Utilization review/utilization management experience
Virginia residency required
Computer literate and comfortable using a variety of applications, especially Word and Excel
Strong critical thinking and organizational skills
Preferred: Current unrestricted RN license issued by the Commonwealth of Virginia
Preferred: Experience monitoring associate productivity (metrics)
Preferred: Prior experience in Medicaid, FIDE, and LTSS markets

Responsibilities

Oversee compliance with turnaround times, productivity metrics, reporting, and call times
Supervise approximately 20 non-clinical medical management specialists
Manage resource utilization to ensure appropriate delivery of care to members and adequate coverage for all tasks and job responsibilities
Participate in cross-functional workgroups to maintain and develop the program
Evaluate current processes of Special Program's support functions and recommend changes for increased efficiencies and improved outcomes
Develop and conduct training programs for staff involved in the program
Extract and manipulate analytical data to present findings to relevant markets and stakeholders
Hire, train, coach, counsel, and evaluate performance of direct reports
Support the Medicaid Medical Management team by managing and overseeing non-clinical medical management specialists to ensure utilization regulatory compliance and member service delivery

Skills

Key technologies and capabilities for this role

Utilization ManagementRegulatory ComplianceTeam SupervisionResource UtilizationProcess ImprovementTraining DevelopmentData AnalysisPerformance EvaluationMedicaid Medical ManagementProductivity Metrics

Questions & Answers

Common questions about this position

Is this a remote position, and are there any location requirements?

This is a virtual eligible role allowing associates to work virtually full-time, with the exception of required in-person training sessions. Virginia residency is required.

What are the required qualifications for this role?

A BA/BS and minimum of 5 years experience in a related field, including minimum of 1 year leadership/management experience, or equivalent combination of education and experience is required.

What does the team structure look like for this manager role?

The role supervises approximately 20 non-clinical medical management specialists.

What preferred qualifications or skills are highlighted for this position?

Utilization review/utilization management experience is a must. A current unrestricted RN license issued by the Commonwealth of Virginia is very strongly preferred, along with experience monitoring associate productivity, prior experience in Medicaid, FIDE, and LTSS markets, and strong critical thinking and organizational skills.

What salary or compensation information is provided for this role?

This information is not specified in the job description.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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