Staff VP Operations - AIM

Position Title:

Staff VP Operations - AIM

Job Description:

Title: Staff VP Operations - AIM

Preferred Location (s): Chicago, IL or Nashville, TN

Responsible for developing the strategic vision, goals, objectives, policies, and decision-making for the organization related to performance and operational issues. Provide management and leadership to Service Experience to drive results and achieve targeted goals.

Responsible for business unit oversight of the account services staff and directing account management activities for large-scale, multi-state/region, and business. Owns the plan P&L and the operational design of cross-sell and renewal opportunities. Develops a deep knowledge of market drivers and develops plans to ensure their team meets or exceeds annual retention and revenue goals through providing operational excellence and building support systems.

In this role, you will manage a large-scale clinical operation with 1000+ associates while partnering across the organization with Clinical Leadership, Client Partnerships, Legal, Compliance, IS&T, Reporting and Analytics, Solutions Management, Human Resources, Learning and Development, and Non-Clinical Service Operations to support service delivery to include new client implementations, solution expansions, contractual compliance and regulatory requirements, clinical and solution strategy.

Primary duties may include, but are not limited to:

• Oversight of all operational areas for the entire book of business; inclusive of but not limited to claims payments and encounter submissions, medical necessity determinations, peer-to-peer consultation with ordering providers, post-determination reviews as delegated by health plan clients, network, reporting, IT and infrastructure, performance guarantees, and corrective action plans.
• Provides leadership and strategic direction to ensure the business meets profitability standards.
• Collaborates with matrix leaders to develop strategies and manage plans to achieve client operational and financial goals.
• Responsible for financial planning/budget programs and the coordination of operations expenses.
• Develop and ensure the continued effectiveness of financial reporting, planning, and infrastructure.
• Provides input to the Product Development team on opportunities to create profitable and efficacious products that meet the strategic operational needs of clients.
• Oversight over clinical utilization management activities
• Accountable for identifying and delivering opportunities to increase Clinical Operations efficiency through a combination of process improvement and automation.
• Participate in the discovery, evaluation, and implementation of new technology or tools from a clinical and operational perspective.
• Oversee integration of clinical guidelines, medical policies, coverage determinations, and state regulations/mandates into the clinical review process
• Oversee Clinical Operations implementation of workforce management tools.
• Hires, trains, coaches, counsels, develops, motivates, and evaluates the performance of direct reports.

Qualifications:

Requires a BA/BS and 8 years of professional leadership and managerial experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• UM and prior authorization experience
• Provider experience
• Experience leading large-scale operations
• Physician leader
• Previous health plan experience
• Utilization management knowledge
• Process improvement/LEAN/Six Sigma
• MBA, MD, or DO

Experience in one or more of these areas would be desirable:

• MSK, Radiology, Sleep, Cardiology, Oncology, Rehab, and/or Interventional pain management

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $153,200 to $262,512.

Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

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, 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.

Job Level:

Staff/Regional VP

Workshift:

Job Family:

CUS > Service Operations

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

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. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World's Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 [email protected] for assistance.

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 [email protected] for assistance.