Director II Medicaid State Ops, Tennessee
Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Director II Medicaid State Ops (COO) serves as a key member of the Wellpoint Tennessee Executive Leadership Team and is responsible for the overall operational performance of the health plan. This role provides strategic and operational leadership across all functional areas, ensuring the delivery of high-quality services, regulatory compliance financial stewardship and exceptional member and provider experiences. This role partners closely with state agency leaders, internal business partners, and market leadership to execute organizational priorities, achieve contractual obligations, and advance Wellpoint's mission.
How will you make an impact:
Develops, directs, plans, and evaluates the goals and objectives for Wellpoint Tennessee. Leads day-to-day health plan operations, ensuring effective execution of strategic priorities and contractual requirements.
In collaboration with the Plan President, establishes overall standards, policies, and objectives for Health Plan in accordance with applicable regulatory requirements.
Ensures alignment and support with overall Medicaid Business Unit mission, goals, and objectives.
Identify operational risks and implement mitigation strategies to ensure continuity, compliance, and performance.
Partner with clinical leadership to ensure delivery of high-quality person-centered care management solutions, promoting operational efficiencies and reducing administrative burden for Case Managers and LTSS Coordinators.
Partner with RVP of provider networks to establish strategy for excellence in network operations, ensuring timely and accurate claims payment and overall provider satisfaction.
Lead implementation of major business initiatives, regulatory changes, and transformation efforts.
Responsible for local marketing and community relations, network development, provider partnerships, provider relations, medical management, case management and quality management programs, performance management/improvement, budgets, complaints and appeals, regulatory and contractual compliance, monthly financials, and reporting.
Hires, trains, coaches, counsels, and evaluate performance of direct reports. Foster a culture of accountability, collaboration, innovation and continuous improvement.
Influence and lead within a highly matrixed environment.
Drive continuous improvement initiatives focused on efficiency, quality, and value creation, across Medicaid and Medicare programs.
Minimum Requirements:
Requires a BA/BS in a related field and minimum of 8 years relevant experience, including in-depth experience in the HMO/healthcare field, minimum of 5 years working with Medicaid and/or Medicare programs; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Master's degree preferred.
Demonstrated experience leading large-scale operational functions and cross-functional teams strongly preferred.
Strong knowledge of Medicaid managed care programs and regulatory requirements strongly preferred.
Strong understanding of claims payment processes, encounter submission requirements, regulatory reporting, and the operational impact of claims and encounter performance on provider satisfaction, compliance, and financial outcomes strongly preferred.
Experience working directly with state agencies, regulators, and external stakeholders strongly preferred.
Experience with LTSS, dual eligible populations, and complex care management programs strongly preferred.
Knowledge of Tennessee Medicaid (TennCare) programs and regulations strongly preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $148,480 to $256,128
Locations: Illinois, Columbus, OH, and Virginia
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
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 elevancehealthjobssupport@elevancehealth.com 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.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) .
