Operations Director - Medicaid

Operations Director - Medicaid

Location: Columbia, South Carolina.

This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our South Carolina Elevance Health PulsePoint locations.

The Operations Director - Medicaid will be responsible for ensuring the appropriate strategy, tactics, and processes are in place to achieve solid organizational operations and oversight. Duties will encompass a close coordination between internal departments and an effective liaison role with Health Plan support services.

How you will make an impact:

• Resolving programmatic challenges related to operations such as member issues, provider claims issues, and contract configuration issues.

• Serving as a bridge to Health Plan support services, potentially involving: Claims, Enrollment, NCC, PDM/PDQ, configuration; Quality, Regulatory Compliance, IT, Reimbursement policy, etc.

• Identifying opportunities for Operational Excellence and creating seamless processes between shared services and the Health Plan.

• Developing and implementing key operational indicators for monitoring and analysis of Health Plan operations.

• Act as a liaison with state regulatory agencies whenever necessary.

Minimum Requirements:

BA/BS degree in Business, Healthcare Administration, or related field with a minimum of 10 years of experience including at least 8 years of in-depth experience in managed care operations is required; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Masters degree is highly preferred.

• Six Sigma Black Belt certification is preferred.

• Expertise in Network LOI and contracting strategy development and support is highly preferred.

• Proven leadership and team guidance abilities is highly preferred.

• Demonstrated experience in working with government relations and framing engagement strategies is highly preferred.

• Hands-on experience with Contraxx system operations is highly preferred.

• Proficiency in managing local provider/network procedures is highly preferred.

• Past success in achieving readiness for various stages of implementation is highly preferred.

• Proven track record in effective hiring and staff management is highly preferred.