Medical Management Operations Manager

Anticipated End Date:

2025-06-30

Position Title:

Medical Management Operations Manager

Job Description:

Location:  This role requires associates to be in-office 1 - 2  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. Alternate locations may be considered.

The Medical Management Operations Manager is responsible for performing specialized functional and technical analyses for complex projects and systems, and devises/modified procedures to solve involved program issues. Provides technical guidance to the Reimbursement Policy teams for implementation and product development, the analysis and identification/development of functional specifications to improve these processes during assigned projects. .

How you'll make a difference:

• Serves as project lead for implementing systems and related technologies and interfaces; coordinates upgrades and new software to support acquisitions and new products.
• Conducts research and functional needs analyses for issues within the Reimbursement Policy areas (including both Corporate and Health Plan levels).
• Identifies gaps and makes recommendations for changes to improve policies, procedures, programs and operations.
• Coordinates data analysis needs for implementation and report specifications (both operational and regulatory).
• Develops and executes tracking tools for reporting.
• Conducts root cause and current state analysis and makes recommendations for process redesign and improvement as supported by new technologies.
• Develops project plans and tracking multiple projects simultaneously.
• Monitors project deliverables and progress through continuous communication with project members.
• Supports and coordinates system related needs; provides technical support and performing tests on system modifications; compiles test plans and test results.
• Provide support to staff during implementations and transition cycles.
• Acts as functional lead for all system technology development as related to Reimbursement Policies (including both Corporate and Health Plan levels).

Minimum requirements:

• Requires a BA/BS in a related field and minimum of 7 years experience in related field, with at least 5 years of experience in healthcare management in a managed care setting and 3 years of leadership/management experience; or any combination of education and experience, which would provide an equivalent background.

Preferred qualifications:

• CPC preferred.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

BSP > Operations

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 a