Strategy & Program Development Director - Payment Integrity Strategy & Planning

Anticipated End Date:

2025-07-07

Position Title:

Strategy & Program Development Director - Payment Integrity Strategy & Planning

Job Description:

Strategy & Program Development Director - Payment Integrity Strategy & Planning

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. Travels to worksite and other locations as necessary.

The Strategy & Program Development Director is responsible for coordinating the relationship of a business unit with internal partners to ensure growth, compliance, and the strategic design and management of enterprise-wide claims editing projects. This role involves planning, budgeting, and implementing initiatives that enhance operational efficiency across Commercial, Medicare, and Medicaid markets. The Director plays a critical role in advancing new initiatives in collaboration with local state partners, managing resources across local markets in a region. Additionally, the position oversees business transformation initiatives aimed at driving efficiency gains, Cost of Care savings, and total program savings. The ideal candidate will possess extensive experience in PI editing, claims, and program management.

How you will make an impact:

• Monitor related legislation and advise senior management on compliance.

• Research new ventures and prospective revenue expansion opportunities.

• Assist in creating the company's strategic and annual plans.

• Develop and implement strategic initiatives to increase Prepay editing value through improved edit penetration rate and efficiency.

• Research and develop new programs to reduce administrative costs.

• Provide oversight and manage multiple complex integration programs, including platform integrations and edit system migrations.

• Facilitate communication of activities, trends, and program progress to executive leadership.

• Direct daily interactions of program and project teams to ensure successful implementation while adhering to constraints of cost, time, and resources.

• Oversee and prioritize workflow transformation efforts.

Minimum Requirements:

Requires a BA/BS degree in a related field and a minimum of 10 years of related experience including 5 years of leadership experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience:

• MBA or BA/BS degree in Business, Finance, Economics, or Healthcare Administration is highly preferred.

• Experience in broad-based, analytically oriented, managed care payor or provider environment is strongly preferred.

• Deep expertise in PI pre-pay editing, implementing requirements, and managing system migration projects and initiatives from both business and IT perspectives

• Strong understanding of analytics to create insights and drive practical strategies as we seek to reduce medical costs is preferred.

• Knowledge and experience in the products and services of the respective industry strongly preferred.

• Experience and knowledge of data analytics, project management, project execution, process improvement and change management experience (strategic and execution) strongly preferred.

• Experience interacting confidently with senior management and executive level stakeholders, as a subject matter expert and comfortable with influencing decision-making preferred.

• Excellent written, oral, presentation and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties strongly preferred. 

• Proficient of Microsoft Office products Excel, Teams, Outlook, PowerPoint, Word and Power BI strongly preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $139,944 to $239,904

Locations: California; Colorado; District of Columbia (Washington, DC); Illinois; Maryland; Minnesota; New York

In addition to your salary, Elevance Health offers benefits such as, a comprehensiv