Job Description:
LOCATION: This position will work a hybrid model and you must reside within 50 miles of our Las Vegas office. You are expected to be in this office 3x per week.
HOURS: General business hours, Monday through Friday.
TRAVEL: Some travel may be required.
The Medicaid State Ops Director is an individual contributor role that is responsible for fiscal and operational management of state regional Health Plans, including coordination between internal departments, ensuring the appropriate strategy, tactics and processes are in place to affect solid organizational operations and oversight.
Primary duties may include, but are not limited to:
- Resolves programmatic challenges related to operations including member issues, provider claims issues, contract configuration issues, etc.
- Serves as liaison to Health Plan support services, which could include: Claims, Enrollment, NCC, PDM/PDQ, configuration; Quality, Regulatory Compliance, IT, Reimbursement policy, etc.
- Leads program development to ensure members, network providers, and community partners successfully participate.
- Identifies opportunities for Operational Excellence and works to create seamless processes between shared services and the Health Plan.
- Develops and implements key operational indicators to be used for monitoring and analysis of the Health Plan operations.
- Along with State CEO and COO, establishes overall standards, policies and objectives for Health Plan in accordance with applicable regular agencies, and serves as a liaison when appropriate.
Required Qualifications
- Requires a BA/BS in Business, Healthcare Administration or related field and minimum of 10 years experience, including minimum of 8 years in-depth experience in managed care operations; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications
- Previous experience developing and overseeing Medicaid State programs is very strongly preferred.
- Masters degree preferred.
- Six Sigma Black Belt preferred.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $128,772 - $193,158
Location(s): Nevada
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
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