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Director I Medicaid State Ops

  • Job Family: Business Support
  • Type: Full time
  • Date Posted:
  • Req #: PS71503


  • DC, Washington



Responsible for developing, directing, planning, evaluating goals and objectives of the business unit for assigned State.

Primary duties may include, but are not limited to:

  • Establishes state/regional strategic plans and objectives to meet business unit goals.
  • Assumes leadership role in implementing corporate initiatives, including special project planning and budget management.
  • Resolves complex financial, legal, or politically sensitive issues.
  • Leads program development to ensure members, network providers, and community partners successfully participate in programs.
  • Manages local provider network including network assessment and development, issue identification and contractual issues (PCP, specialist, hospital, and ancillary).
  • Plans, directs, and secures the resources (people, material, data and support) for staff to effectively accomplish operational needs and strategic initiatives.
  • Maintains appropriate staffing levels and provides oversight of indirect reporting associates.
  • Motivates associates to accomplish goals and objectives.
  • Develops and implements budget and a strong team through training and effective organizational development practices.
  • In collaboration with and in support of the National Field Operations, assumes all management functions for a state/regional/field office.
  • Ensures all policies and procedures related to Field Operations are compliant with all applicable laws and regulations governing the State Sponsored Business.
  • Champions initiatives by developing and managing State rate negotiations and key relationships with government, regulatory, Medicaid/SCHIP and other stakeholders as appropriate.
  • Provides coordinated analysis and regional solutions to issues.
  • Guides implementation of programs and strategies.
  • Collaborates with senior management to develop and implement new programs to enhance relationships with key stakeholders and to promote programs and services.
  • Collaborates with Marketing Management to develop marketing strategies for member recruitment and retention for all assigned lines of business.
  • Directs strategic planning on marketing, network maintenance and development and program advocacy in assigned area.
  • Resolves programmatic challenges related to program operations including member issues, provider claims and provider network.
  • Manages projects and issues across departmental and divisional lines to facilitate timely resolution. Represents business unit on national/state/regional boards, task forces, and work groups that impact the health care delivery system and other key health care issues.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements

  • Requires a BA/BS in a related field and a minimum of 8 years of management experience in the health care field; specific contract negotiation experience in both provider network management and state rate contracting; or any combination of education and experience, which would provide an equivalent background.

 Preferred Skills, Capabilities, and Experiences

  • Master's degree 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 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 for assistance.

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