Description
Florida Medicare organization is represented by 4 different heath plan brands (Simply Healthcare Plans, HealthSun, Freedom and Optimum), with all four obtained through an acquisition at various points in time (2015-2018). Each brand has a unique history with various levels of integration into a broader Elevance Medicare organization (Simply being most integrated). Over the course of the years, each health plan maintained a high level of quality and Star performance, with 2 brands being at 4.5 Stars and 2 Plans and 5 Stars (the only two plans in Elevance Medicare portfolio). The plans have a strong track record of performance and growth, which is a result of a strong collaboration with value-based providers in the market.
Stakeholders : Functions reporting to the leader across all four brands: Enrollment, Claims, Configuration, Provider admin, grievances and appeals, audit and recovery, Member Services, Mailroom, OTC, PMO
Reports to the President Fl. Medicare
Direct Reports: 6-9 Span of control 300
Responsible for providing strategic executive leadership relating to strategy operational design, business and system requirements. Needs to have exposure and experience with leading high value initiatives and integration activities, in a matrixed organization with a focus on member and provider experience. Should be adept at developing best practices through management of multiple health plans.
Primary duties may include, but are not limited to:
- Manages external and internal stakeholder relations strategies and drives the decision-making process across the management team.
- Recommends operating model and framework in support of strategic goals in a complex environment.
- leads change management efforts for impacted areas and has experience with integration of acquired assets.
- Recommends and establishes optimal operating and/or clinical systems in support of the strategy which drive organizational effectiveness and efficiencies through the automation and technology enablement.
- Serves as a key advisor to the market CEO and represents the market in enterprise forums.
- Initiates relationship and joint planning activities with strategic business owners to understand the business direction, educate the planners on impact, and return on investment.
- Acts as a functional lead for all implementation teams.
- Identifies, recommends, and implements external software and/or creates clinical systems to extract data from various sources.
- Acts as a champion and visionary for emerging technologies.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requirements
- Requires a BA/BS in Business Administration, Management Information Systems, Computer Science, Engineering, or a related field.
- Minimum of 14 years’ experience in the health care operations or information technology field, providing configuration/programming support for a claims and/or administration platform.
- Minimum of 10 years management experience; or any combination of education and experience, which would provide an equivalent background.
Strongly Preferred
- MBA preferred.
- Experience in the assessment, selection, design, development, implementation, and support of emerging technology within a mid to large enterprise
This is a critical role for the market, responsible for the operational oversight of all four Medicare brands.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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.
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 – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 ability@icareerhelp.com for assistance.