Medicaid Contract Implementation Management Director at Elevance Health

Indianapolis, Indiana, United States

Elevance Health Logo
Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Medicaid, Health InsuranceIndustries

Requirements

  • BA/BS degree
  • Minimum 6 years experience in the health care or related field (or any combination of education and experience providing equivalent background)

Responsibilities

  • Participates in development, review and implementation of corporate initiatives and program strategies to support State/Alliance contract and business needs
  • Manages resolution of complex financial, legal, or other escalated issues
  • Acts as lead to assigned shared services partners on behalf of the local market, including triage and management of change request inventory, and priority management
  • Expedites and implements key operational indicators to be used for monitoring and analysis of the Health Plan operations
  • Monitors, resolves, and communicates operational State/Alliance-mandated metrics to ensure compliance with State/Alliance requirements
  • Ensures policies and procedures related to field operations are compliant with all applicable laws and regulations governing the state sponsored business
  • Manages local vendor operations (as applicable by market), monitors compliance with State/Alliance contract, and creates and administers corrective actions to ensure compliance
  • Manages operational support of provider organization partners; ensures members, network providers, and community partners successfully participate in programs; advises and implements operations components of local provider network strategy
  • Leads cross functional project initiatives and process improvement activities

Skills

Key technologies and capabilities for this role

MedicaidContract ImplementationProgram ManagementState ComplianceVendor ManagementOperational MetricsFinancial ResolutionLegal ComplianceChange ManagementPolicy Development

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This is a hybrid position requiring associates to be in-office 3 days per week in Indianapolis, IN, to foster collaboration while providing flexibility for virtual work. Candidates not within a reasonable commuting distance from the location will not be considered unless an accommodation is granted.

What are the minimum education and experience requirements?

The role requires a BA/BS and a minimum of 6 years of experience in the health care or related field, or any combination of education and experience that provides an equivalent background.

What preferred skills or experiences are highlighted for this position?

Preferred qualifications include experience in the HMO/healthcare field, working knowledge of Medicaid and/or Medicare programs with specific Medicaid experience preferred, and the ability to analyze workflows, processes, supporting systems, and procedures to identify improvements.

What does the hybrid work policy aim to promote?

The hybrid model combines structured office engagement with virtual work autonomy to promote collaboration, connectivity, productivity, work-life balance, and a dynamic, adaptable workplace.

What makes a strong candidate for this director role?

Strong candidates will have healthcare experience, preferably in Medicaid, along with skills in analyzing workflows and processes for improvements, and the ability to manage complex issues, lead cross-functional projects, and ensure regulatory compliance.

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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