Director I Medicare Operations
3 weeks ago
Join Elevance Health, a leading health company dedicated to improving lives and communities, as a Director I Medicare Operations. This role is part of our National Government Services (NGS) division, which administers government contracts for Medicare and partners with the Centers for Medicare and Medicaid Services.
Key Responsibilities:- Direct multiple business function operations teams on Tier I contract with primary responsibility for Program Management and/or Medicare Integrity Operations.
- Oversee the daily activities of the Quality Review staff in performing reviews of operational quality issues.
- Manage the performance of compliance to determine the adequacy of the internal controls and identifies workflow efficiencies.
- Ensure deficiencies in compliance are identified and recommendations are prepared as necessary to strengthen the control environment.
- Drive innovation throughout the assigned business function areas to reduce the overall costs associated with performing the CMS statement of Work requirements.
- Strong Financial Acumen; ability to manage department financials to include: annual forecasting, monthly oversight, ability to adequately convey trends and resolve variances.
- Ability to develop a 2-3 year operational strategy plan and manage oversight of plans.
- Frequent and regular contact with various representatives of CMS and peer contractor staff.
- BA/BS in a related field and minimum of 7 years professional/leadership experience with CMS, including strategic planning, project management, Medicare or related healthcare insurance or medical policy field, minimum of 3 years management experience.
- Understanding of technology and ability to partner with IT to create a roadmap for enhancements and automation, preferred.
- Experience with managing operational workloads, productivity and planning forecasts and creating formalized plans to resolve issues, preferred.
- Understanding of the Agile PI Planning Process, preferred.
- Innovation and Change mindset; must have experience managing associates through change, preferred.
- Market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs.
- Comprehensive benefits package, including medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources.
- Hybrid Workforce Strategy, with opportunities to work remotely and in-person.
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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