Location: This is a hybrid position going into the Des Moines, IA office 4-10 times per month. Must reside within 50 miles of Des Moines, IA or be willing to relocate to reside within 50 miles of the Des Moines office.
The Director GBD Special Programs is responsible for the fiscal and operational management/implementation and oversight of a special product/programs such as long term service and supports (LTSS), Foster Care, Intellectual and developmental disabilities (IDD),or HIV/Aids, etc. This position will oversee long-term care Provider reviews, Utilization Reviews, Enrolled Member satisfaction surveys, and Enrolled Member health and welfare; Care Coordination and Community-Based Case Management teams, care plan development and care plan implementation.
How you will make an impact:
- Develops and implements the strategic vision, goals, objectives, policies and decision making for the special product/program organization.
- Oversees all health plan medical management programs including concurrent review, pre-certification, discharge planning, case management, disease management, provider profiling, quality management, accreditation, health promotion and outreach.
- Facilitates and collaborates with medical management staff to identify gaps and improve processes.
- Oversees the design and development of provider contracts and partnerships to achieve quality, cost management, and strategic business development objectives; develops and negotiates strategic provider contracts on behalf of the Plan.
- Leads the performance management/earnings improvement activities for the special product/program organization.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Requires a BA/BS and minimum of 10 years relevant experience, including 5 years of LTSS policy and have comprehensive understanding of CMS rules and regulations.
- 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.
- RN or other medical professional with extensive experience in providing Care Coordination.
Preferred Skills, Capabilities and Experiences:
- MPA, MPH, MSN or MBA with Health Care concentration preferred.
- Strong people leadership experience 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. 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.
Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and 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 – 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 firstname.lastname@example.org for assistance.