Health Insurance Operations Director jobs in South Carolina

Description

Operations Director - Medicaid

Location: Columbia, South Carolina.

This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our South Carolina Elevance Health PulsePoint locations.

The Operations Director - Medicaid will be responsible for ensuring the appropriate strategy, tactics, and processes are in place to achieve solid organizational operations and oversight. Duties will encompass a close coordination between internal departments and an effective liaison role with Health Plan support services.

How you will make an impact:

• Resolving programmatic challenges related to operations such as member issues, provider claims issues, and contract configuration issues.
• Serving as a bridge to Health Plan support services, potentially involving: Claims, Enrollment, NCC, PDM/PDQ, configuration; Quality, Regulatory Compliance, IT, Reimbursement policy, etc.
• Identifying opportunities for Operational Excellence and creating seamless processes between shared services and the Health Plan.
• Developing and implementing key operational indicators for monitoring and analysis of Health Plan operations.
• Act as a liaison with state regulatory agencies whenever necessary.

Minimum Requirements:

BA/BS degree in Business, Healthcare Administration, or related field with a minimum of 10 years of experience including at least 8 years of in-depth experience in managed care operations is required; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Masters degree is highly preferred.
• Six Sigma Black Belt certification is preferred.
• Expertise in Network LOI and contracting strategy development and support is highly preferred.
• Proven leadership and team guidance abilities is highly preferred.
• Demonstrated experience in working with government relations and framing engagement strategies is highly preferred.
• Hands-on experience with Contraxx system operations is highly preferred.
• Proficiency in managing local provider/network procedures is highly preferred.
• Past success in achieving readiness for various stages of implementation is highly preferred.
• Proven track record in effective hiring and staff management is highly preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.