Digital Solutions Business Manager at Elevance Health leading analysis and partnership on digital health solutions. Evaluating product lines and financial viability across engineering, IT, and finance.
About the role
- Manager I in Medicaid Medical Management overseeing non-clinical specialists ensuring compliance and service delivery. Responsible for training and managing a team to improve program efficiency.
Responsibilities
- 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
- 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
Requirements
- Requires a BA/BS
- minimum of 5 years experience in a related field
- minimum of 1 year leadership/management experience
- Utilization review/utilization management experience is a must
- A current unrestricted RN license issued by the Commonwealth of Virginia is very strongly preferred
- Experience monitoring associate productivity (i.e. metrics)
- Prior experience in Medicaid, FIDE, and LTSS markets is very helpful
- Must be computer literate and comfortable using a variety of applications, especially Word and Excel
- Strong critical thinking and organizational skills are essential
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical benefits
- dental benefits
- vision benefits
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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