Healthcare Operations Manager

3 weeks ago


Miami, Florida, United States Elevance Health Full time
Care Management Role Overview

This position is a virtual opportunity that aligns with our company's virtual policy. The ideal candidate will reside within 50 miles of one of our Elevance Health locations.

Key Responsibilities
  • Perform care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member healthcare across the care continuum.
  • Conduct assessments to identify individual needs and develop a specific care management plan to address objectives and goals as identified during assessment.
  • Implement care plans by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractural arrangements.
  • Monitor and evaluate the effectiveness of the care management plan and modify as necessary.
  • Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
  • Negotiate rates of reimbursement as applicable.
  • Assist in problem-solving with providers, claims, or service issues.
Requirements
  • Bachelor's degree in a health-related field.
  • Minimum of 3 years of clinical experience.
  • Bi-lingual Spanish-speaking candidate preferred.

Elevance Health is a health company dedicated to improving lives and communities. 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.

We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. Elevance Health operates in a Hybrid Workforce Strategy, and 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. 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.



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