Strategy & Program Development Director - Payment Integrity Strategy & Planning

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Travels to worksite and other locations as necessary.

The Strategy & Program Development Director is responsible for coordinating the relationship of a business unit with internal partners to ensure growth, compliance, and the strategic design and management of enterprise-wide claims editing projects. This role involves planning, budgeting, and implementing initiatives that enhance operational efficiency across Commercial, Medicare, and Medicaid markets. The Director plays a critical role in advancing new initiatives in collaboration with local state partners, managing resources across local markets in a region. Additionally, the position oversees business transformation initiatives aimed at driving efficiency gains, Cost of Care savings, and total program savings. The ideal candidate will possess extensive experience in PI editing, claims, and program management.

How you will make an impact:

• Monitor related legislation and advise senior management on compliance.

• Research new ventures and prospective revenue expansion opportunities.

• Assist in creating the company's strategic and annual plans.

• Develop and implement strategic initiatives to increase Prepay editing value through improved edit penetration rate and efficiency.

• Research and develop new programs to reduce administrative costs.

• Provide oversight and manage multiple complex integration programs, including platform integrations and edit system migrations.

• Facilitate communication of activities, trends, and program progress to executive leadership.

• Direct daily interactions of program and project teams to ensure successful implementation while adhering to constraints of cost, time, and resources.

• Oversee and prioritize workflow transformation efforts.

Minimum Requirements:

Requires a BA/BS degree in a related field and a minimum of 10 years of related experience including 5 years of leadership experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience:

• MBA or BA/BS degree in Business, Finance, Economics, or Healthcare Administration is highly preferred.

• Experience in broad-based, analytically oriented, managed care payor or provider environment is strongly preferred.

• Deep expertise in PI pre-pay editing, implementing requirements, and managing system migration projects and initiatives from both business and IT perspectives

• Strong understanding of analytics to create insights and drive practical strategies as we seek to reduce medical costs is preferred.

• Knowledge and experience in the products and services of the respective industry strongly preferred.

• Experience and knowledge of data analytics, project management, project execution, process improvement and change management experience (strategic and execution) strongly preferred.

• Experience interacting confidently with senior management and executive level stakeholders, as a subject matter expert and comfortable with influencing decision-making preferred.

• Excellent written, oral, presentation and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties strongly preferred. 

• Proficient of Microsoft Office products Excel, Teams, Outlook, PowerPoint, Word and Power BI strongly preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $139,944 to $239,904

Locations: California; Colorado; District of Columbia (Washington, DC); Illinois; Maryland; Minnesota; New York

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

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.

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. Unless 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.

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 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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 elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.