Medicaid Contract EnforcementResolution Manager

Anticipated End Date:

Position Title:

Job Description:

LOCATION: This is a hybrid role and you will work 12 days per week from our Las Vegas office. You must be within 50 miles/1 hour commute of Las Vegas.

HOURS: General business hours Monday through Friday.

The Medicaid Contract/Implementation Management Manager (Medicaid Contr/Implmnt Mgmt Mgr) is an individual contributor role responsible for guiding Medicaid State/Alliance objectives established by Health Plan leadership to meet business unit goals. You will oversee and be responsible for claims management including development and implementation of the claims processing and management information systems payment of claims in accordance with state and federal law development of processes for cost avoidance and Encounter Data reporting requirements.

Primary duties may include but are not limited to:

• Supports the development review and implementation of corporate initiatives programs to support State/Alliance contract and operational needs.

• Provides guidance to operational leaders in resolving complex financial legal or other escalated issues.

• Guides shared services partners on behalf of the local market including triage and management of change request inventory.

• Plans the implementation of key operational indicators to be used for monitoring and analysis of the Health Plan operations while supporting the development of business requirements to ensure compliance with State/Alliance contract.

• Participates in development and review of policies and procedures related to field operations.

• Supports vendor management operations as required by market; supports development of corrective actions to ensure compliance.

• Participates in operational support of provider organization partners; ensure members network providers and community partners successfully participate in programs.

Required Qualifications

• Requires a BA/BS and minimum 4 years experience in the health care or related field; or any combination of education and experience which would provide an equivalent background.

To be successful in this role the ideal candidate will have:

• A proficient and indepth knowledge of Medicaid programs.

• Ability to conduct claims research (the elements of a claim how claims process coverage reimbursement etc.

• An understanding of Encounter Data reporting oversight (requirements for submitting encounter data to the State; accountability to ensure timeliness and accuracy.

• Process Improvement (understand the overall business including the ability to implement processes that result in efficiencies and cost savings).

• Data Analytics/Strategic Resolution (identify the issue and obtain the data needed to form a plan/conclusion for resolution).

• Technical acumen including proficiency in Microsoft Excel and Facets claims software and configuration capabilities.

For candidates working in person or remotely in the below location(s) the salary* range for this specific position is $.

Location: Nevada

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 nondiscriminatory 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 or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

Job Level:

Workshift:

Job Family:

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 marketcompetitive 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. Candidates must reside within 50 miles or 1hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 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 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.