Director Enterprise Reimbursement Strategy

Director Enterprise Reimbursement Strategy 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 Enterprise Reimbursement Strategy will be responsible for leading Cost of Care Ideation for Elevance Health contracts with a focus on services managed by Carelon Health, a subsidiary of Elevance Health. Will work cross-functionally with Ideation Leads for other services, aligned to clear and distinct operational archetypes, the associate will vet potential programs including accountability over proper modeling standards, operational assessments, and driving alignment to most appropriate execution entity within the global organization. This role will also take on the Ideation Profiling opportunities across all service types, including those managed directly by Elevance and/or Carelon Health How you will make an impact: Development and implementation of strategic initiatives to control unit medical costs. Evaluation of annual CMS reimbursement guidelines and recommendations as they relate to control over medical claims cost. Research and develop new contracting and reimbursement methodologies. Facilitates the communication of activities, emerging trends, and best practices with provider solution leadership across all lines of business. Directs the daily interaction with and requests for reimbursement subject matter expertise and support. Oversee and prioritize workflow. Coordinates with Reimbursement Policy/Edit team as necessary to achieve strategic reimbursement related goals. Works closely with CoC team on PADU (Preferred/Acceptable/Discouraged/Unacceptable). Hires, trains, coaches, counsels, and evaluates the performance of direct reports. Minimum Requirements: Requires a BA/BS degree in Business, Finance, Economics, or Healthcare Administration and a minimum of 10 years of related experience in broad-based, analytically oriented, managed care payor or provider environment required. Experience must include project management, CMS payment methodology application, and financial/economic business modeling. Preferred Skills, Capabilities and Experiences: Advanced knowledge of managed care provider and claims payment systems and process is essential and strongly preferred. CPA, MBA or other equivalent advanced degree is preferred. 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 View email address on click.appcast.io 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 ( . #J-18808-Ljbffr Elevance Health