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.

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