Clinical Audit Platform Implementation Director
3 days ago
Carelon Payment Integrity, a proud member of the Elevance Health family of companies, is dedicated to recovering, eliminating, and preventing unnecessary medical-expense spending. Our Complex & Clinical Audit Team is seeking a highly skilled Implementation Director, Clinical Audit Platform to join our team.
About the RoleThis is a hybrid position that will work 1-2 days per week from our Mason, OH work location. However, we will consider candidates near any US Elevance Health corporate work location. As an Implementation Director, you will provide consultative ownership of the work migration to a new modern digital platform. You will work with the broader Audit team to understand how we work today and how the work needs to evolve, gather requirements from users, and partner with product and IT teams to define enhancements, implement the new platform, and migrate current work to the new platform.
Key Responsibilities- Provide support to the implementation process in the presentation of these programs and advise on programmatic changes needed based on data collected.
- Develop relationships with audit line leaders and work with them to translate business needs to platform requirements, standard workflows, and operational interfaces.
- Serve as a super user, trainer, and subject matter expert on the audit platform and inform resolution of operational issues.
We are looking for a highly skilled individual with a BS in nursing or other related clinical area and a minimum of 6 years related experience, including program development, marketing, and clinical practice. Preferred skills and experiences include:
- Healthcare clinical technology and program management experience.
- Experience implementing new tools, technology, and digital systems such as platforms.
- PMP certification.
- Experience gathering requirements from business users and working with Product/IT teams to translate those user stories.
- Experience with Payment Integrity and Complex and Clinical Audit experience such as Hospital Bill Audit (HBA), Diagnosis Related Group (DRG) audits, Itemized Bill Review (IBR), and Ancillary/Specialty Audits.
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.
What We OfferWe 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.
Equal Employment OpportunityElevance 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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