**LOCATION: This is a virtual eligible role. Virginia residency is required.**
**HOURS: General business hours, Monday through Friday.**
_This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development._
Responsible for supporting the Medicaid Medical Management team by managing and overseeing non-clinical medical management specialists to ensure utilization regulatory compliance and member service delivery.
**Primary duties may include, but are not limited to** **:**
+ Oversees compliance with turnaround times, productivity metrics, reporting, and call times.
+ Supervises approximately 20 non-clinical medical management specialists.
+ Manages resource utilization to ensure appropriate delivery of care to members, adequate coverage for all tasks and job responsibilities.
+ Participates in cross-functional workgroups created to maintain and develop program.
+ Evaluates current processes of Special Program's support functions; recommends changes for increased efficiencies and improved outcomes.
+ Develops and conducts training programs for staff involved in the program.
+ Extracts and manipulates analytical data to present findings to relevant markets and stakeholders.
+ Hires, trains, coaches, counsels, and evaluates performance of direct reports.
**Required Qualifications**
+ Requires a BA/BS and minimum of 5 years experience in a related field, including minimum of 1 year leadership/management experience; or any combination of education and experience, which would provide an equivalent background.
**Preferred Qualifications**
+ Utilization review/utilization management experience is a must for this position.
+ A current unrestricted RN license issued by the Commonwealth of Virginia is very strongly preferred.
+ Experience monitoring associate productivity (i.e. metrics) is preferred.
+ Prior experience in Medicaid, FIDE, and LTSS markets is very helpful.
+ Your must be computer literate and be comfortable using a variety of applications, especially Word and Excel.
+ Strong critical thinking and organizational skills are essential for this role.
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
[email protected] 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.