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Director of Medicare Operations
hace 1 mes
Job Summary:
We are seeking a highly skilled and experienced Director I Medicare Operations to join our team at Elevance Health. As a key member of our leadership team, you will be responsible for directing multiple business function operations teams on Tier I contract with primary responsibility for Program Management and/or Medicare Integrity Operations.
Key Responsibilities:
- Direct the daily activities of the Quality Review staff in performing reviews of operational quality issues.
- Manage the performance of compliance to determine the adequacy of the internal controls and identifies workflow efficiencies by using the Quality Assurance Surveillance Plan (QASP) used by CMS to evaluate performance on the contract.
- Ensure deficiencies in compliance are identified and recommendations are prepared as necessary to strengthen the control environment.
- Drive innovation throughout the assigned business function areas to reduce the overall costs associated with performing the CMS statement of Work requirements.
- Strong Financial Acumen; ability to manage department financials to include: annual forecasting, monthly oversight, ability to adequately convey trends and resolve variances.
- Ability to develop a 2-3 year operational strategy plan and manage oversight of plans.
- Frequent and regular contact with various representatives of CMS and peer contractor staff. Ability to meet with customer and deliver polished presentations when needed.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Travels to worksite and other locations as necessary.
Requirements:
- Requires a BA /BS in a related field and minimum of 7 years professional/leadership experience with CMS, including strategic planning, project management, Medicare or related healthcare insurance or medical policy field, minimum of 3 years management experience; or any combination of education and experience, which would provide an equivalent background.
- This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.
Preferred Skills, Capabilities, and Experience:
- Understanding of technology and ability to partner with IT to create a roadmap for enhancements and automation, preferred.
- Experience with managing operational workloads, productivity and planning forecasts and creating formalized plans to resolve issues, preferred.
- Understanding of the Agile PI Planning Process, preferred.
- Innovation and Change mindset; must have experience managing associates through change, preferred.
About Elevance Health:
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.
Benefits:
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.
Location:
This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our PulsePoint locations.
