Location: Remote in the state of California; preferably within 50 miles of an office location.
Build the Possibilities. Make an extraordinary impact.
The Director of Special Programs is responsible for directing and overseeing the California Medicaid operations, business strategy and alignment for special products/programs such as Enhanced Care Management, Community Supports, and Palliative Care. This includes responsibility for Cal AIM program performance, provider and community collaboration/engagement, behavioral health integration, clinical care management, policy development, process improvement/program enhancements, managing interdependencies and risks, and developing growth opportunities.
How you will make an impact:
- Develops and implements the strategic vision, goals, objectives, policies and decision making for the special product/program organization.
- Directs the development, planning, prioritization, approval, implementation and compliance of on-going external client facing programs.
- Oversees the design and development of provider contracts and partnerships to achieve quality, cost management, and strategic business development objectives.
- Leads the performance management/earnings improvement activities for the special product/program organization.
- Manages contract compliance, including enrollment, disenrollment and regulatory reporting
- Oversees overall operations of external member facing programs
- Monitors authorization process review and reporting
- Interfaces with providers of care regarding billing and claims issues
- Establishes program governance when needed to assure response to issue escalation
- Develops program budget and ensures program meets its stated objectives
- Provides subject matter expertise in response to day-to-day business issues
- Researches applicable subject matter practices; and remains aware of industry trends
- Manages external client facing relationships and partners with corporate and regional business areas
- Develops communication documents and training criteria related to external client facing program success measures
- Provides leadership to program managers and project managers
- Hires, trains, coaches, counsels, and evaluates performance of direct reports
- Requires a BA/BS and minimum of 10 years relevant experience, including prior management experience in a managed care setting with operations, budgeting and forecasting, process improvement, or planning experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
- Medicaid experience strongly preferred.
- Cal AIM experience strongly preferred.
- MPA, MPH, MSN or MBA with Health Care concentration preferred.
- RN or LMSW license preferred.
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. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
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 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 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.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 email@example.com for assistance.